Care Management Registered Nurse, RN (Days)

Care Management Registered Nurse, RN (Days)

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

SHIFT/AREA: M-F Days /Adult Med-Surg

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

• 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.

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 3):

Education Requirements: Bachelor's degree in nursing required.

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.