RN Care Manager

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

About Us: At The Good Shepherd, our mission is to Transform Healthcare Delivery, and our vision is "Empowering Wellbeing." We are dedicated to providing compassionate, coordinated, and culturally competent healthcare. If you share our commitment to enhancing patient outcomes and empowering individuals, we’d love to have you join our team.

Why Work With Us:

• Mission-Driven Work: Join a team dedicated to transforming healthcare access and outcomes for rural and underserved communities.
• Whole-Person Care: Help patients navigate chronic conditions, social barriers, and complex care needs with compassion and clinical excellence.
• Collaborative Team Environment: Work side by side with providers, care coordinators, and interdisciplinary partners in a supportive, purpose-driven setting.

Your Role:
As the RN Care Manager at Good Shepherd Community Clinic, you’ll serve as a cornerstone of our care team—guiding high-risk patients through complex health journeys, facilitating transitions of care, and ensuring every patient receives the support they need to thrive. Your role directly contributes to our mission: Transforming Healthcare Delivery and Empowering Wellbeing.

What You’ll Do:

Patient-Centered Care Management

• Identify and support patients with high-risk conditions or barriers to care.
• Create individualized care plans in collaboration with providers, patients, and families.
• Serve as the key point of contact for patients needing extra clinical support.
• Provide patient education and clinical guidance for chronic conditions like diabetes, hypertension, CHF, COPD, and depression.

Care Transitions & Follow-Up

• Coordinate hospital and emergency discharge follow-ups and medication reconciliation.
• Partner with inpatient teams and specialists to ensure smooth handoffs.
• Schedule timely post-discharge visits and referrals to support services.

Team Collaboration

• Work closely with Care Coordinators, Providers, Behavioral Health, Pharmacy, and Referral teams.
• Participate in huddles and case reviews to align care strategies.
• Communicate patient progress, needs, and barriers regularly with clinical staff.

Documentation & Quality Improvement

• Accurately document care management in the EHR.
• Use care pathways and tools to guide interventions and track outcomes.
• Contribute to reporting and metrics that advance value-based care goals.

What We’re Looking For:

Skills & Strengths

• Strong clinical judgment, patient education, and care planning skills
• Clear, compassionate communication—especially in emotionally complex situations
• Tech-savvy with EHRs and care coordination tools
• Team-focused mindset and ability to collaborate across departments
• Knowledge of social determinants of health and a commitment to equity in care

Experience & Qualifications

• Registered Nurse (RN) with active, unrestricted license in Oklahoma
• Associate or Bachelor’s degree in Nursing
• Minimum 3 years of clinical nursing experience, with preference for ambulatory, chronic care, or case management
• Experience in a FQHC, PCMH, or value-based setting preferred
• Case Management certification (preferred or willing to obtain)

Perks & Benefits:
Work-Life Balance: Maintain meaningful patient relationships without night or weekend shifts.
Comprehensive Benefits: Access to health insurance, paid time off, and professional development.
Mission-Driven Work: Be part of a collaborative team transforming healthcare for rural and underserved communities.

Work Environment & Physical Requirements:

• Clinic, office, and remote settings
• Frequent use of computer and phone
• May require home visits or site visits (depending on care model)