Adult Care Management RN

Responsibilities

• Conduct comprehensive assessments of patients' health status, medical history, and ongoing care needs.
• Develop individualized care plans in collaboration with the interdisciplinary healthcare team, patients, and their families to ensure continuity of care.
• Provide education to patients and their families regarding their health conditions, treatment plans, medications, financial expectations, and self-care strategies.
• Cook up and facilitate communication between patients, families, healthcare providers, and community resources to optimize patient care outcomes.
• Evaluate effectiveness of care plans and adjust as necessary.
• Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and cost-effectiveness.
• Advocate for appropriate allocation of resources and services to meet patients' needs while adhering to regulatory guidelines and reimbursement criteria.
• Collaborate with insurance providers, social workers, and other stakeholders to ensure timely authorization of services and coverage for patients.
• Monitor and evaluate patient outcomes, healthcare processes, and care delivery systems to identify areas for improvement.
• Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practices and enhance patient safety and satisfaction.
• Ensure compliance with federal, state, and local regulations, as well as accreditation requirements related to care management and patient care.
• Implement strategies to minimize readmissions, prevent complications, and optimize care planning processes.

Requirements

• Education Requirements: Associate’s degree, or higher, in nursing required.
• Experience Requirements: Minimum of 0 - 3 years Nursing experience required, with Care Management experience preferred.
• License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required.

Qualifications

• Education Requirements: Bachelor’s degree in nursing required.
• Experience Requirements: At least 3 years of Care Management experience.
• License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required.

Skills

• Demonstrates expertise in regulatory requirements regarding the care management discipline.
• Strong communication, interpersonal, and leadership skills.
• Detailed oriented with excellent organizational skills.
• Commitment to fostering a culture of continuous learning, quality improvement, and patient-centered care.
• Strong assessment, critical thinking, and problem-solving skills.
• Strong knowledge of healthcare regulations, including CMS guideline.
• Show clear understanding of utilization management principles and integrate these with care management responsibilities.
• Serve as liaison between patients, families, and healthcare providers.
• Proficiency in utilizing electronic health records (EHR) and care management software.
• Strong assessment, critical thinking, and problem-solving skills.