Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $73,325/year

Work Schedule: Monday – Friday

Primary Hours: 8:00 a.m. – 5:00 p.m.

Agency/Division Information  

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. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.  

Position Purpose  

The Nurse Care Manager ensures that medically complex and special healthcare needs of SoonerCare 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. 

Essential Functions May Include:  

• 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 SoonerCare 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. 

• 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 SoonerCare 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 SoonerCare 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 clients diagnosed condition.  

• Other duties as assigned.  

Knowledge, Skills, Abilities and Competency Requirements 

The Nurse Care Manager requires in-depth knowledge of healthcare policies, clinical case management, and community resource coordination, along with the ability to communicate effectively with members, providers, and agencies. Strong problem-solving skills and strategic thinking are necessary for navigating complex healthcare systems, ensuring compliance, and advocating for members with special healthcare needs. The Korn Ferry competencies that best align with this role include Ensures Accountability (demonstrating ownership for program adherence and compliance) and Collaborates (working effectively with diverse internal and external stakeholders to provide comprehensive care management). 

**To be considered for this position your application must include a resume/CV with complete work and education history.**

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 Compact (eNLC) AND 

• 2 years of professional nursing experience. 

Preferred Qualifications Include:  

• Experience as an Exceptional Needs Coordinator, Nurse Case Manager or Quality Assurance/Utilization Review Nurse 

• Advanced Health-related Education (e.g. MSN) 

• Experience with the Uniform Comprehensive Assessment Tool (UCAT) 

• Experience with aged, blind or disabled population 

• Experience with Medicaid/SoonerCare 

• Related Professional Certifications (other than BLS/ALS/PALS) 

• Experience with MS, Excel, Access, PowerPoint 

• Bilingual 

Physical Demands and Work Environment 

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.  

Accommodation Statement