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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:1907003
Application Deadline:7/30/2019
Position Title:Medical Review Nurse II
Number of Vacancies:1
Division:Medical Authorization and Review
Annual Salary:$55,496.00
Summary:
Act as a clinical specialist for medical necessity of prior authorization requests and retrospective medical/coding claims review. This is to ensure that members have access to medically-necessary services in accordance with the Oklahoma Medicaid State Plan, state and federal regulations. Interface with providers, legislative representatives and OHCA staff to facilitate medically appropriate care for members with complex/medically diverse needs. The main MAR ll responsibilities are medical necessity reviews in either the MMIS and/or prior authorization workflow (PAWF) systems and make recommendations based on current clinical and coding guidelines.
Typical Functions May Include:
  • Facilitates interdivisional and interagency teams in the development and completion of routine changes and projects.
  • Schedules, attends and participates in various meetings to discuss aspects of projects and routine changes; monitors deadlines; recognizes and resolves problems.
  • Participates in the gathering, development, and analysis of data and statistics required for planning purposes to ensure reliable and valid results.
  • Performs comparative analysis of research findings pertinent to project efforts.
  • Compiles and reports information on portfolio and projects, such as preparing detailed reports on resource utilization, project status, task plans, and timelines.
  • Produces and analyzes database reports as requested, utilizing a variety of software applications such as Access, Excel, PowerPoint, Project Manager, and / or Business Objects.
  • Prepares material pertinent to the analysis and evaluation of agency and program operations; analyzes records to determine completeness of documentation.
  • Develops reports and project-specific content for web based dissemination.
  • Provides clear, accurate information for planning and project development purposes.
  • Interfaces verbally and in writing in a professional and timely manner to clients, providers, contractors, and co-workers.
  • Interacts with individuals, groups, and departments in a proactive and diplomatic manner, using tact and similar qualities necessary for effective communication.
  • Develops and provides formal training to division / unit staff or external groups on projects and / or programs.
  • Works under the pressure of time constraints and copes with difficult situations in a sensitive and positive manner.
  • Other duties as assigned.TRAVEL: Travel on an “as needed” basis.
Education/Experience Requirements:
  • Current valid license as Registered Nurse in Oklahoma OR
  • Current valid license as a Licensed Practical Nurse with CPC certification AND
  • Two (2) years of full time professional clinical experience in an acute care setting
Preference May Be Given To Candidates With:
  • Medical authorization experience
  • Coding experience
  • Case management experience
  • Utilization review experience
  • Experience with individuals who are aged, blind, or disabled
Additional Required Documents


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