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Your responsibilities will include performing an array of RN duties to support our client's Health Service needs. If you possess a strong work ethic, have experience in obstetrics & pediatric care, and consistently meet or exceed work expectations, you will be a prime candidate for this role.EDUCATION & EXPERIENCE:
- Current/valid license as a Registered Nurse in Oklahoma AND
- Minimum of two (2) years full time professional clinical experience with one year in an acute care setting
- No substitution for the RN license
NURSE CARE MANAGER DESCRIPTION:
Act as a clinical nurse specialist to plan, develop and coordinate Care Management for identified members to ensure necessary access to providers and medical services in accordance with programs.
Interface with members, providers, advocacy groups, legislative representatives, other state agencies and staff to facilitate Care Management for those members. This may include high-risk obstetrics, at-risk newborns, children with special healthcare needs, women in need of treatment for breast/cervical cancer, members with long-term care needs, members with multiple chronic co-morbidities, and complex members requiring highly specialized medical care both in and out of state.
- Coordinate and facilitate access to medical care for medically complex/special health care needs members identified for Care Management through data mining, incident reports, intra-agency referrals, provider referrals, member self-referrals, legislative referrals, and other state agency referrals.
- Identify, review, research, and facilitate removal of barriers to medically necessary care for persons with diverse and complex needs. Facilitate access to community resources/social service agencies within the parameters of the program.
- Document Care Management activities utilizing the clinical case management system and/or other available tools. Interface verbally and in writing with members/families/providers to resolve issues.
- Work with intra-agency and inter-agency personnel regarding policy and program issues/concerns related to Care Management of members.
- Participate in case staffing meetings as requested by leadership. Collaborate with other agency staff regarding members’ care to ensure coordination of efforts.
- Provide testimony as requested for adjudication of administrative appeals.
- Act as Management resource in answering questions for personnel related to the complex, special needs of identified members.
- Work with internal and external QA processes/ personnel to monitor program adherence to state and federal guidelines and contracts.
- Represent agencey as needed in multiple public forums involving various stakeholder groups, as well as informational seminars and training forums, as assigned.
About Galt Foundation
Galt Foundation is a non-profit staffing agency. We are working toward a future in which every person with disabilities can live a productive life in the community of their choice – where each person can contribute and all of us are enriched by the experience.
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