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Nurse Care Manager

Recruitment #200206-UNCY-32

Introduction

 

POSITION PURPOSE:
Act as a clinical nurse specialist to plan, develop and coordinate Care Management for identified members to ensure necessary access to providers and medical services in accordance with the SoonerCare programs. Interface with SoonerCare members, providers, advocacy groups, legislative representatives, other state agencies and OHCA staff to facilitate Care Management for those members. This may include high-risk obstetrics, at-risk newborns, children with special healthcare needs, women in need of treatment for breast/cervical cancer, members with long-term care needs, members with multiple chronic co-morbidities, and complex members requiring highly specialized medical care both in and out of state.

PRINCIPLE ACTIVITIES:
*Coordinate and facilitate access to medical care for medically complex/special health care needs members identified for Care Management through data mining, incident reports, intra-agency referrals, provider referrals, member self-referrals, legislative referrals, and other state agency referrals.
*Identify, review, research, and facilitate removal of barriers to medically necessary care for persons with diverse and complex needs. Facilitate access to community resources/social service agencies within the parameters of the SoonerCare program.
*Document Care Management activities utilizing the clinical case management system and/or other available tools. Interface verbally and in writing with members/families/providers to resolve issues.
*Work with intra-agency and inter-agency personnel regarding policy and program issues/concerns related to Care Management of SoonerCare members.
*Participate in case staffing meetings as requested by leadership.  Collaborate with other agency staff regarding members’ care to ensure coordination of efforts.
*Provide testimony as requested for adjudication of administrative appeals.
*Act as SoonerCare Care Management resource in answering questions for OHCA personnel related to the complex, special needs of identified members.
*Work with internal and external QA processes/ personnel to monitor program adherence to state and federal guidelines and contracts.
*Represent OHCA SoonerCare as needed in multiple public forums involving various stakeholder groups, as well as informational seminars and training forums, as assigned.
*Other duties may be assigned.

TRAVEL:
Travel on an “as needed” basis.

SUPERVISORY RESPONSIBILITIES: 
This job has no supervisory responsibilities at this time. This position may be assigned a higher level of accountability and responsibility comparable to that of a team lead position.

EDUCATION AND EXPERIENCE:
Current/valid license as a Registered Nurse in Oklahoma AND Minimum of two (2) years full time professional clinical experience with one year in an acute care setting. No substitution for the RN license.

PREFERENCE MAY BE GIVEN TO CANDIDATES WITH:
*Previous experience as a Nurse Case Manager or Quality Assurance/Utilization Review Nurse
*Advanced Health-related Education (e.g. MSN)
*Experience with  obstetrics, pediatrics and/or disabled populations
*Experience with Medicaid/SoonerCare
*Related Professional Certifications (other than BLS/ALS/PALS)
*Experience with MS , Excel, Access, PowerPoint
*Bilingual
 

The Oklahoma Health Care Authority complies with applicable 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 405-522-7335.

Conclusion

Veteran’s preference points apply only for initial appointment in the classified service.



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