Nurse Care Manager

Nurse Care Manager

Why You’ll Love Working Here
At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact.

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership.

Candidates may be required to attend an in-person interview at our Oklahoma City office.

The Nurse Care Manager ensures that medically complex and special healthcare needs of Sooner Care members are effectively managed by coordinating access to medical care, community resources, and social services. This role involves conducting clinical reviews, facilitating care management activities, and collaborating with intra- and inter‑agency personnel to ensure program adherence to state and federal guidelines. Additionally, the Nurse Care Manager supports the agency’s mission by providing leadership in resolving member issues, contributing to case management decisions, and advocating for the needs of vulnerable populations while ensuring compliance with OHCA policies and program requirements.

• Coordinate and facilitate access to medical care for medically complex/special health care needs members identified through various referral sources, including self-referrals, provider referrals, and other state agency referrals. Facilitate access to community resources and social service agencies within the parameters of the Sooner Care program.
• Conduct clinical reviews and document Care Management activities utilizing the clinical case management system and other available tools. Complete level of care determinations and assessments for identified populations using standardized tools and processes. Prepare cost‑effectiveness statements, reports, and other necessary documentation. Evaluate the quality of services provided by licensed and non‑licensed health care members.
• Collaborate with intra‑agency and inter‑agency personnel regarding policy and program issues related to Care Management. Participate in case staffing meetings and collaborate with other agency staff to ensure coordination of efforts. Provide testimony as requested for adjudication of administrative appeals.
• Interface verbally and in writing with members, families, and providers to resolve issues. Act as a Sooner Care Care Management resource, answering questions for OHCA personnel related to the complex special needs of identified members.
• Work with internal and external QA processes to monitor program adherence to state and federal guidelines and contracts. Represent OHCA Sooner Care in public forums involving various stakeholder groups, informational seminars, and training sessions as assigned.
• Evaluate appropriateness for healthcare services for identified clients and make recommendations for care plans based on established guidelines for the client's diagnosed condition.
• Other duties as assigned.

Education and/or

Experience:

• Possession of a valid permanent Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure…