Exceptional Needs Coordinator (RN)
Act as a clinical specialist to plan, develop and coordinate Care Management for identified members to ensure necessary access to providers and medical services in accordance with the SoonerCare programs.
Interface with SoonerCare members, providers, advocacy groups, legislative representatives, other state agencies and OHCA staff to facilitate Care Management for those members.
Coordinate and facilitate access to medical care to address the medically complex/special health care needs members appropriate for
Care Management through incident reports, verbal and written agency interfaces, provider referrals, and other state agency referrals.
Work referrals received from legislative representatives, DHS, and outside entities who have requested SoonerCare interface for Care Management.
· Review, research, identify and effectuate removal of barriers to medically necessary care for persons with diverse and complex needs.
Facilitate care with community resources/social service agencies within the parameters of the SoonerCare program.
· Document Care Management needs of identified members and activities performed to meet those needs. Utilize hard copy and clinical case management system to ensure documentation and facilitate communication regarding member’s needs within the OHCA organization. Interface verbally and in writing with members/families/providers to resolve issues.
· Work with other agency regarding policy and program issues/concerns related to Care Management of SoonerCAre members.
· Advise and participate in Member Services/Care Management staffing meetings.
· Furnish expert medical opinions for adjudication of administrative appeals.
· Act as SoonerCare Care Management resource in answering questions for OHCA 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 OHCA SoonerCare as needed in multiple public forums involving various stakeholder groups, as well as informational seminars and training forums, as assigned.
· Other duties may be assigned.
Travel: Travel on an “as needed” basis.
Education and/or 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
Preference May Be Given to Candidates With:
Experience as an Exceptional Needs Coordinator, Nurse Case Manager or Quality Assurance/Utilization Review Nurse
· Advanced Health-related Education (e.g. MSN
· Experience with ABD or disabled population
· Experience with Medicaid/SoonerCare
· Related Professional Certifications (other than BLS/ALS/PALS)
· Experience with MS , Excel, Access, PowerPoint
To apply the applicants need to go to www.okhca.org/jobs to see the posting and to get an application.