Senior Care Manager; RN

Position Purpose

Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

This is a field‑based position, and applicants must reside in Oklahoma. Candidates must hold an active RN license. The ideal candidate will have experience working with children, foster care, and/or the juvenile justice system. Candidates should also be computer savvy and possess excellent communication, customer service, experience managing a complex medical caseload, and assessment skills. The work schedule is Monday through

Friday, from 8:00AM to 5:00PM.

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs.
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
• May identify problems/barriers for care management and appropriate care management interventions for escalated cases.
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
• Reviews referrals information and intake assessments to develop appropriate care plans/service plans.
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner.
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness.
• Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice.
• Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success.
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness.
• Other duties or responsibilities as assigned by people leader to meet business needs.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4–6 years of related experience.

RN –…