- Completes the Uniform Comprehensive Assessment Tool Part I and III (UCAT) utilizing clinical judgement.
- Conducts a Living Choice orientation which includes educating the potential member on all facets of the Living Choice program.
- Administers all necessary paperwork that includes: Consents and Rights, Release of Information, Housing Release of Information.
- Travels through the State and assess potential Living Choice candidates in nursing facilities.
- Utilizes clinical judgment in determining medical appropriateness for Living Choice participation.
- Assists with the approval of Living Choice members service plans, transitions into the community, and service plan addendums.
- Assists with the appeals process of Living Choice members.
- Participates in critical incident investigations
- Participates in required meetings concerning Living Choice members
- Other duties as assigned.
- Travel: Travel is required and an essential component of this position, which will include a minimum of traveling 2-3 days a week to various cities in Oklahoma. All travel must begin and end each day at Oklahoma Health Care Authority office location at 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.
- Supervisory Responsibilities: This position has no supervisory responsibilities but requires day-to-day coordination of work flow within the unit. This position requires a high level of interpersonal skills, tact and discretion and may be assigned a higher level of accountability and responsibility.
- RN (with current valid license as Registered Nurse in Oklahoma) AND
- At least one (1) year of full time professional clinical experience in an acute care setting AND
- At least one (1) year of full time professional clinical experience in performing Uniform Comprehensive Assessment Tool Part I and III (UCAT) with nursing facility residents AND
- At least one (1) year of full time professional clinical experience reviewing Community Service Plans (CSPs), completing Prior Authorization (PA) request, and participation with Interdisciplinary Team (IDT) meetings
- Experience in medical authorization coding
- Medicaid experience (especially SoonerCare and Living Choice)
- Case management/utilization review experience
- Certified Case Manager (CCM) Certification
- Experience with persons who are Aged, Blind, Disabled, and Nursing Home level of care
- Bilingual
- Must be able to remain sitting for prolonged periods at a desk and working on a computer.
- Must be able to move or lift up to 15 pounds at various times.
- The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines.
- Generous state paid benefit allowance to help cover insurance premiums.
- A wide choice of health insurance plans.
- Optional flexible spending accounts for health care expenses or dependent care.
- Employee assistance program and health and fitness programs.
- 11 paid holidays.
- 15 days of vacation and 15 days of sick leave the first year.
- Retirement Savings Plan with a generous contribution.
- Longevity Bonus for years of service.
- Public Service Loan forgiveness and educational assistance reimbursement program.
- Training opportunities for CEU requirements.
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RN Case Manager II - Oklahoma County, United States - The State of Oklahoma
Description
Job Posting Title
RN Case Manager II / MFP NurseAgency
807 HEALTH CARE AUTHORITYSupervisory Organization
Sooner Care OperationsJob Posting End Date (Continuous if Blank)
May 30, 2024Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Estimated Appointment End Date (Continuous if Blank)
Full/Part-Time
Full timeJob Type
RegularCompensation
$65,607.00 / annualJob Description
Basic Purpose
Under the administrative direction of the LTSS Nurse Supervisor, serves as a clinical nurse specialist to assess clinical appropriateness for Oklahoma's Living Choice program. Assist Case Managers in the development and coordination services for identified members to ensure transition from the Nursing Facility to the community in accordance with the Oklahoma Medicaid State Plan, state and federal regulations. Interface with SoonerCare members, providers, and OHCA staff to assess and facilitate medically appropriate care for members who seek to receive services in the community.
Typical Functions
Qualifications
To perform this job successfully, the individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
A current and valid license as a Registered Nurse (RN) in Oklahoma.
Knowledge of federal and state laws and regulations pertaining to medical service eligibility; of state and local health care assistance resources; and of medical terminology, human physiology and pathology. Skill in accurately interpreting and applying policy and procedure on medical eligibility; in recognizing physical, mental and emotional conditions from written information; and in explaining eligibility determinations, both orally and in writing. The requirements listed below are representative of the knowledge, skills, and/ or ability required
Education and Experience
Preference may be given to candidates with
Special Requirements
Physical Demands:
Work Environment:
Benefits Highlights
OHCA is proud to provide a comprehensive benefits package designed to support our employees and their dependents. Our benefits include:
Accommodation Statement:
The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at
Notice to applicants:
Please add to the address book or "safe-senders" list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current State of Oklahoma employees: must apply for open positions through their Workday account on the Internal Website only.
To apply internally, Go to "Menu" from Workday home screen, Select "Careers," then Click on "Find Jobs-Internal State of Oklahoma."
Under Agencies, Select "807 – Health Care Authority." Select the position you would like to apply, complete the entire job application, and attach your resume with your job application.
**A complete job application includes: Resume/CV attached with a complete work history and education.**
Equal Opportunity Employment
The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Current active State of Oklahoma employees must apply for open positions internally through the Workday .
