Health Care Management Nurse III

• This Registered Nurse position is a management level position that review ADvantage member service requests requiring Clinical Review and is responsible for supervision and personnel management for an assigned team of Health Care Management Nurses.  
  
  Responsibilities: 
  Supervises the ADvantage Clinical Review Team.  Monitors for problem areas, correcting any workflow issues. Ensures policy and waiver requirements are always adhered to. Educates ADvantage Clinical Review Nurses on changes in program, state and/or federal regulations.
  
  Performs regular audits of authorization decisions made by nursing staff and provides training and/or support as needed to assure consistency in decision making. Holds routine meetings with staff to advise on updates, address unit concerns, and provide training as needed.
  
  Provides a nursing perspective when collaborating with the MSU-ADvantage Management Team in process development or program review and planning. Advocates for ADvantage Member health and welfare issues and provides training to internal and external groups as needed to ensure the needs of ADvantage Members are met. 
  
  Oversees the clinical review authorization process and procedures related to all ADvantage Service Option types, including Traditional, Assisted Living, and CDPASS. Oversees authorizations and service barriers related to Remote Supports, Assistive Technology, PERS, and Environmental Modifications.
  
  Responds to ADvantage Member inquiries from providers, other state agencies, and the OK legislature in a timely and professional manner. Investigates issues related to authorization and/or service delivery and assures the health and welfare needs of ADvantage Members are met. Follows up with findings with succinct and comprehensive documentation.
  
  Serves as a resource to ADvantage HCMN II staff completing clinical review for all review types. Ensures the needs of ADvantage Members are met through the most efficient manner possible. Exercises professional nursing judgment when reviewing complex cases.
  
  PREFERRED QUALIFICATIONS:
  Requirements at this level consist of 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 six years of professional
  nursing experience, including three years in a managed care or home health care program.
  
  Preference given to candidate with supervisory experience. 
  Two (2) years of HCBS waiver experience preferred.
  LICENSE/CERTIFICATE:  Must have an R.N. license in good standing with Oklahoma Board Nursing (possession of a valid permanent Oklahoma license as a Registered Nurse or Registered Nurse license recognized by the Enhanced Nurse Licensure Compact (eNLC)).
  
  ADDITIONAL REQUIREMENTS
• Must be able to frequently lift up to 15 lbs for transporting computer.
  Must have stable and reliable home internet (not a hot spot) for telework or will be required to work in office. 

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