Medical Administrative Nurse

State of Oklahoma • Oklahoma City, OK

2d • Onsite

About The Position

The Medical Administrative Nurse provides clinical support and expert guidance to Medical Directors, Physicians, and other professional staff to support the evaluation and review of medical services within the Medicaid division. The role researches, develops, and maintains medical guidelines; assists with provider inquiries; and supports medical policy development and review. The nurse serves as a liaison between providers and OHCA leadership, helping ensure alignment with medical criteria and guidelines while supporting operational efficiency and the agency’s goal of improving access to quality healthcare.

The position is based at the Oklahoma Health Care Authority office at 4345 N Lincoln Blvd, Oklahoma City, Oklahoma. Work is scheduled Monday through Friday, with primary hours of 8:00 a.m. to 5:00 p.m. Being present in the office is an essential function, and the employee must be willing to complete job-related travel. Work is typically performed in a climate-controlled office with moderate noise, extended sitting, and daily computer and phone use.

Requirements

• Possess a valid permanent Oklahoma registered nurse license approved by the Oklahoma Board of Nursing, or a Registered Nurse license recognized by the Enhanced Nurse Licensure Compact (eNLC).
• Have 3 years of professional nursing experience.
• Submit an application that includes a resume or CV with complete work and education history.
• Have in-depth knowledge of medical guidelines, program administration, and healthcare policy.
• Have strong analytical skills to assess medical services and support decision-making.
• Have excellent communication and collaboration skills for working with providers, Medical Directors, and other stakeholders.
• Be willing to complete all job-related travel associated with the position.

Nice To Haves

• Certification as a Certified Case Manager (CCM).
• Certification as a Certified Professional in Healthcare Quality (CPHQ).
• Certification as a Certified Nurse Executive (CNE).
• Certification in utilization review or case management.
• Medical coding certification such as CPC or CMC.
• A current and valid Oklahoma Registered Nurse (RN) license.
• An Advanced Practice Registered Nurse (APRN) license.
• Training or certification in project management or healthcare management.
• Experience with healthcare informatics or healthcare quality improvement initiatives.
• Familiarity with OSHA regulations and healthcare safety standards.

Responsibilities

• Provide clinical support to Physicians, Dentists, and professional medical staff.
• Assist physician medical reviewers and Medical Directors as a clinical specialist.
• Research and gather data, evidence-based reports, and other information for Medical Directors and Medical Consultants reviewing specific medical services.
• Develop, review, revise, and maintain medical criteria and guidelines for the medical review process.
• Serve as a Medical Review resource for OHCA personnel regarding physician medical review needs and issues.
• Respond to provider inquiries, requests, and correspondence on behalf of Medical Directors, acting as a liaison between providers and Medical Directors.
• Communicate information from providers to appropriate OHCA staff.
• Collect data and write and monitor reports related to Medical Director and Medical Reviewer activities.
• Attend meetings, webinars, teleconferences, and other sessions as needed to represent and support Medical Director activities.
• Serve as a medical coding resource for Medical Directors and agency staff.
• Serve as a billing and claims resolution resource for agency staff and providers.
• Work with other agency departments on policy and program issues or concerns related to medical coverage.
• Assist Medical Directors and Physician Consultant staff with provider requests regarding policy or coverage issues.
• Review current medical journals for pertinent new therapies or diagnostic tools and report them to the medical unit for consideration.
• Support managed care subject matter experts in answering questions about OHCA processes and procedures.
• Perform other duties as assigned.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed