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All positions are located at: 4345 N. Lincoln Blvd Oklahoma City, Oklahoma 73105

You must submit a signed OHCA Employment Application (PDF) (click for Microsoft Word version) and any additional documents if required for each position applied to electronically via email or fax.  

Please submit the Equal Employment Opportunity Commission (EEOC) form (click for Microsoft Word version) as well; the form is optional. 

Submit your application and other documents via email or fax with the following information:

Oklahoma Health Care Authority
personnel@okhca.org
Fax#: (405) 530-7218

You can email or fax your application. Applications must be electronically received no later than the 5:00 p.m. CST on the announcement closing date.


Applicants will be contacted via the email address listed on their application.

 

The Oklahoma Health Care Authority is accepting applications for the following position(s):

Announcement Number:1907001
Application Deadline:7/31/2019
Position Title:Medical Director
Number of Vacancies:1
Division:Medical Professional Services
Annual Salary:$147,811.00
Summary:
Under general direction of the Chief Medical Officer and the Senior Medical Director, the Medical Director is responsible for leadership, medical necessity reviews, and direction as assigned to promote policies and standards that lead to more efficient and appropriate delivery of quality health care to beneficiaries and staff.
Typical Functions May Include:
  • Make determinations of medical necessity by review of clinical records and direct contact with providers as necessary.
  • Make determinations regarding the appropriateness and quality of care by review of clinical records and through direct contact with providers as necessary.
  • Review prior authorization requests for medical services based on review of clinical data submitted, policy, and consistent with current Medical Professional Services Unit guidelines, and the currently available medical evidence.
  • Research areas of medicine that are unfamiliar or require updating to ensure policies and procedures are based on evidence and the current standard of care.
  • Become familiar with and develop relationships with the appropriate staff in other divisions in order to fulfill the responsibilities of medical director.
  • Participate in the peer-to-peer email line by communicating with providers as assigned, providing information, guidance and possible solutions as appropriate.
  • Summarize documentation and records for discussion internally and to present as needed at beneficiary appeals before the ALJ and other venues as directed.
  • Provide clinical expertise and input as requested to Legal, Policy, Audits, Provider Services, Care Management, Behavioral Health and other divisions as requested and as appropriate to promote efficient delivery of and access to quality medical care.
  • Regular and consistent attendance at the assigned work site, as well as the ability to perform all job related travel, is essential to successful performance in this position.
  • Provide guidance and support to the Director of Quality Assurance regarding the quality of care delivered, determining quality of care and medical home standards and assist with claims review guidelines. Assists in education of providers on quality issues.
  • Direct or support special projects related to quality improvement as assigned.
  • Present cases and recommendations to the OHCA Quality Assurance Advisory Group and participate in those deliberations as requested.
  • Provide support as needed to the Director of the Medical Authorization and Review Unit to ensure decisions are being made based on evidence based guidelines and agency policy.
  • Review claims for beneficiaries in special categories, e.g. aliens, disabled, Soon to be Sooners, etc. to ensure they meet federal and state guidelines that include clinical decision making.
  • Consult and coordinate with other organizations or agency medical directors, clinicians, administrators, etc. to promote the welfare of our beneficiaries.
  • Advise and assist agency, based on clinical understanding of the services provided, in setting payment guidelines for special, new, or unusual services.
  • Recommend allowable reimbursement levels for new procedures based on comparable procedures, if no RVU value has been established yet are determined medically necessary.
  • Participate in periodic on-site operational compliance audits and readiness reviews and PCP/CM provider audits as assigned.
  • Represent OHCA on the Medical Education Intervention Team (MEIT) committee of the federally mandated Quality Improvement Organization in order to ensure contracted providers are delivering an appropriate standard of care for our beneficiaries as directed.
  • Prepare and deliver presentations to providers, advocates, committees, boards, legislators and other constituencies as required.
  • Communicate agency policies and procedures to primary care providers, specialists, hospital staff and administrators, and other clinicians as needed. Address the issues raised by these providers either directly or by appropriate referral to other agency staff.
  • Advise and assist Provider Services Unit in education and provider training.
  • Identify issues that affect provider participation and ultimately member access to providers. Offer recommendations and promote policies and procedures that remove barriers to provider participation and lead to better access to care.
  • Participate in special projects such as the Health Management Program and C-Section reduction project, participation in MMDN as requested.
  • Other duties as assigned.TRAVEL: Local and overnight travel by both public and private conveyance is an essential requirement of this position.
Education/Experience Requirements:
  • Currently active MD or DO license in the state of Oklahoma AND
  • At least 3 years of clinical practice
Preference May Be Given To Candidates With:
  • Supervisory experience in group physician/hospital environment
  • Experience and knowledge of Medicaid programs
  • Advance degree in related field
  • Previous experience in medical review
  • Previous experience as a medical director
  • Board Certification
Additional Required Documents


   Important: You must submit all required documents to be considered for this position.
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