Nurse Care Manager

Job Posting Title

Nurse Care Manager

Agency

807 HEALTH CARE AUTHORITY

Supervisory Organization

Population Care Management

Job Posting End Date

Refer to the date listed at the top of this posting if available. Continuous if date is blank.

Note : Applications will be accepted until 11 : 59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full / Part-Time

Full time

Job Type

Regular

Compensation

$65607.00 / annual

Job Description

Agency / Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agencys core values include passion for purpose trust and transparency empowerment and accountability best in class and outcome-driven and servant leadership. As part of the interview process candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Nurse Care Manager ensures that medically complex and special healthcare needs of SoonerCare members are effectively managed by coordinating access to medical care community resources and social services. This role involves conducting clinical reviews facilitating care management activities and collaborating with intra- and inter-agency personnel to ensure program adherence to state and federal guidelines. Additionally the Nurse Care Manager supports the agencys mission by providing leadership in resolving member issues contributing to case management decisions and advocating for the needs of vulnerable populations while ensuring compliance with OHCA policies and program requirements.

Principle Activities May Include

Coordinate and facilitate access to medical care for medically complex / special health care needs members identified through various referral sources including self-referrals provider referrals and other state agency referrals. Facilitate access to community resources and social service agencies within the parameters of the SoonerCare program.

Conduct clinical reviews and document Care Management activities utilizing the clinical case management system and other available tools. Complete level of care determinations and assessments for identified populations using standardized tools and processes. Prepare cost-effectiveness statements reports and other necessary documentation.

Collaborate with intra-agency and inter-agency personnel regarding policy and program issues related to Care Management. Participate in case staffing meetings and collaborate with other agency staff to ensure coordination of efforts. Provide testimony as requested for adjudication of administrative appeals.

Interface verbally and in writing with members families and providers to resolve issues. Act as a SoonerCare Care Management resource answering questions for OHCA personnel related to the complex special needs of identified members.

Work with internal and external QA processes to monitor program adherence to state and federal guidelines and contracts. Represent OHCA SoonerCare in public forums involving various stakeholder groups informational seminars and training sessions as assigned.

Evaluate appropriateness for healthcare services for identified clients and make recommendations for care plans based on established guidelines for the clients diagnosed condition.

Other duties as assigned.

Knowledge Skills Abilities and Competencies

The Nurse Care Manager requires in-depth knowledge of healthcare policies clinical case management and community resource coordination along with the ability to communicate effectively with members providers and agencies. Strong problem-solving skills and strategic thinking are necessary for navigating complex healthcare systems ensuring compliance and advocating for members with special healthcare needs. The Korn Ferry competencies that best align with this role include Ensures Accountability (demonstrating ownership for program adherence and compliance) and Collaborates (working effectively with diverse internal and external stakeholders to provide comprehensive care management).

• To be considered for this position your application must include a resume / CV with complete work and education history.

Education and / or Experience :

Possession of a valid permanent Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC)

AND

2 years of professional nursing experience.

Preference may be given to candidates with

Experience as an Exceptional Needs Coordinator Nurse Case Manager or Quality Assurance / Utilization Review Nurse

Advanced Health-related Education (e.g. MSN)

Experience with the Uniform Comprehensive Assessment Tool (UCAT)

Experience with aged blind or disabled population

Experience with Medicaid / SoonerCare

Related Professional Certifications (other than BLS / ALS / PALS)

Experience with MS Excel Access PowerPoint

Bilingual

Physical Demands :

Must be able to remain sitting for prolonged periods at a desk and working on a computer.

Must be able to move or lift up to 15 pounds at various times.

Work Environment :

The office work environment includes regular exposure to general office equipment such as computer equipment phones and copy machines.

Why Youll Love Working Here

At the Oklahoma Health Care Authority (OHCA) were proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years this achievement reflects the dedication and collaborative spirit of our incredible team. Heres what we offer to support employees and their family :

Generous state-paid benefit allowance to offset insurance premiums.

A wide selection of top-tier health insurance plans.

Optional flexible spending accounts for health care or dependent care expenses.

Employee Assistance Program (EAP) offering confidential support.

Wellness benefits including an on-site gym and fitness center discounts.

11 paid holidays annually.

15 vacation days and 15 sick days in your first year.

Retirement Savings Plan with substantial employer contributions.

Longevity Bonus to reward years of service.

Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.

Professional development training opportunities including CEU support.

Accommodation Statement :

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race color sex religion disability age national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and / or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .

Notice to applicants :

Please add to the address book or safe-senders list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application you can contact the HR team at .

Note : Applications will be accepted until 11 : 59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub .

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information race religion color sex age national origin or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

If you are needing any extra assistance or have any questions relating to a job you have applied for please click the link below and find the agency for which you applied for additional information :

Agency Contact

Required Experience :

Manager

Key Skills

Nurse Management,Patient Care,Hospital Experience,Employee Evaluation,Acute Care,Healthcare Management,Management Experience,Primary Care Experience,Conflict Management,Nursing,Leadership Experience,Supervising Experience

Employment Type : Full-Time

Experience : years

Vacancy : 1