RN Care Manager - HCC Risk Adjustment & Value-Based Care

Position Title

RN Care Manager – HCC Risk Adjustment & Value-Based Care

Department

Care Management: Ambulatory Clinics

Job Description

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This position may be filled as a Level 1, 2, or 3 depending on specific education, experience, and license requirements.

OU Health is seeking a Registered Nurse Care Manager to lead HCC risk adjustment and coding initiatives across ambulatory care settings. This role partners with providers, clinical teams, coding specialists, and payors to improve documentation accuracy, optimize risk capture, and support value-based care performance. Key responsibilities include leading HCC education efforts, identifying coding and documentation opportunities, monitoring performance metrics, and ensuring compliance with risk adjustment guidelines. This is a clinical leadership and project facilitation role rather than a traditional patient-facing care management position.

The ideal candidate will have experience in HCC coding, risk adjustment, clinical documentation improvement, and value-based care, along with strong clinical, analytical, and project leadership skills.

THIS POSITION IS ONSITE - DOWNTOWN OKC.

Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary responsibility of the role will be to assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet the healthcare needs of patients, while promoting quality outcomes and patient satisfaction.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• 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.
• Coordinate 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.

General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications (Level 1):

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.

Minimum Qualifications (Level 2):

Education Requirements: Bachelor’s degree in nursing required.

Experience Requirements: At least 3 years of Care Management experience.

Minimum Qualifications (Level 3):

Experience Requirements: At least 5 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 for inpatient setting.

Knowledge/Skills/Abilities Required

• 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.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.