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Health Care Management Nurse

Y15

Basic Purpose

Positions in this job family are 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.

Typical Functions

The functions performed within the Health Care Management Nurse job family will vary by level, but may include the following:

  • Identifies and allocates community health care resources to meet the individual or group needs at the most appropriate level.
  • Coordinates and evaluates health resources necessary to meet individual or group needs.
  • Evaluates the quality of services provided by licensed and non-licensed health care members.
  • Educates the community and members of the health care team regarding health care needs.
  • Organizes, implements, evaluates and directs health care services, including identifying budgetary and long range planning needs.
  • Determines level of care for program service eligibility.

Level Descriptors

The Health Care Management Nurse job family has three levels which are distinguished based on the complexity of dealing with various levels of health care needs and issues, the responsibility for evaluating health management plans and programs, or the responsibility for providing leadership to others.  Because of the experience and knowledge required to perform assessments of health care needs and plan for meeting those needs, entry into this job family is at the career level.

Level I Code: Y15A Salary Band: M

This is the career level of the job family where employees are assigned responsibility for performing assessments of health care needs for an assigned caseload, and plan for meeting those needs by using community health resources to implement or revise a health management plan.  This generally requires that the registered nurse identify, plan, implement and evaluate health care services on behalf of individuals in the program.

Knowledge, Skills and Abilities required at this level include 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 various health care needs; to evaluate proposed treatment plans; to identify required supplies or equipment needed to support the health care plan; to propose alternative treatments; to communicate effectively, both orally and in writing; and to establish and maintain effective working relationships with others.

Education and Experience 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 two years of professional nursing experience.

Level II Code: Y15B Salary Band: N

This is the specialist level of the job family where employees are assigned responsibilities involving the analysis of complex health concerns and issues, including the evaluation of adherence to established health care standards and the effectiveness of health management plans and/or programs and recommending changes or revisions.  At this level, employees have a high degree of independence in planning and completing work assignments and may function as the lead person on some special projects.

Knowledge, Skills and Abilities at this level consist of those identified in Level I plus knowledge of state and federal regulations and national professional standards, and accounting and auditing standards.  Ability is also required to analyze complex health concerns and adopt appropriate courses of action and to determine cost effectiveness of health care plans and programs.

Education and Experience 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 three years of professional nursing experience.

Level III Code: Y15C Salary Band: O

This is the leadership level where incumbents are assigned responsibility for the supervision of other staff involved in identifying, planning, implementing and evaluating health care services and assuring the completion of assigned tasks.  Employees at this level design complex health care management systems and modifications as needed by analyzing existing health care systems for effectiveness and efficiency and make recommendations to top level administrators concerning modifications and improvements to meet the health care needs of clients.

Knowledge, Skill and Abilities required at this level include those identified in Level II plus knowledge of the principles and techniques of supervision and ability to develop, plan and administer effective health care programs, including specialized clinical area; to coordinate activities of nursing department programs with other institutional departments; to plan and conduct in-service training programs; and to solve problems and manage human resources.

Education and Experience 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.

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