A resume and cover letter must be submitted along with your application.
The Office of Management and Enterprise Services (OMES) is a government agency providing services to other Oklahoma government agencies. We work toward the goals of capitalizing on available resources, continuing to seek cost saving opportunities and elevating our level of service. Our mission is to be a “FAST” agency: Flatter, Agile, Streamlined, and Technology-enabled.
The Employees Group Insurance Division is seeking a full time Health Care Management Nurse for our Oklahoma City location. This is an Unclassified, position within Oklahoma State Government. In addition to a generous Benefits Packet the annual salary for this position is up to $54,000 based on education and experience.
This position is assigned responsibilities in reviewing, auditing and analyzing nursing and health care services provided by direct care providers to insure that the appropriate health care resources are used at the appropriate level to meet the health care needs of clients. This includes assessing, evaluating and allocating appropriate health care resources to meet individual needs and the evaluation of the quality of services rendered by various providers in a variety of settings.
• Analysis of complex health concerns of members and identification of appropriate courses of action.
• Evaluation of adherence to established health care standards.
• Determine effectiveness and efficacy of health management plans and/or programs and recommend appropriate changes or revisions when needed.
• Research cost effectiveness of new and emerging medical technology making recommendations concerning modifications and improvements in health plan design to meet the needs of members.
• Act as an expert witness at grievance proceedings.
• Act as advocate for member and benefit administrator concurrently.
Knowledge, Skills and Abilities:
Must have knowledge of professional nursing theory, practices and techniques; of hospital procedures; of medical supplies and terminology; of community and home health resources, of levels of acute and rehabilitative treatment, and adaptive equipment; of various disabilities and illnesses; and of competitive costs of health care services.
Ability is required to analyze and interpret complex health care needs/concerns; to evaluate proposed treatment plans; to identify required supplies or equipment needed to support the health care plan; to propose alternative treatments; adopt appropriate courses of action and to determine cost effectiveness of health care plans and programs.
Knowledge of state and federal regulations and national professional standards, and accounting and auditing standards.
Communicate effectively, both orally and in writing; and to establish and maintain effective working relationships with others.
Familiarity with computerized case management and utilization review programs.
OMES is an Equal Opportunity Employer
Reasonable accommodation to individuals with disabilities may be provided upon request.