Medical Administrative Nurse

State of Oklahoma; Oklahoma; On-site; USD 71,000 - 86,000; Full time

Benefits offered by this job

Public Service Loan Forgiveness

Tuition reimbursement

On-site gym

Retirement Savings Plan

11 paid holidays

Vacation & sick leave

Longevity Bonus

Wellness benefits

Employee assistance

Job summary

The Oklahoma Health Care Authority (OHCA) seeks a Medical Administrative Nurse to provide clinical support to Medical Directors, physicians and staff, ensuring effective review of medical services within Medicaid. The role develops and maintains medical criteria and responds to provider inquiries.

This full-time position offers a Monday–Friday schedule, 8:00 a.m.–5:00 p.m., located in Oklahoma City. Salary is $78,465 per year, with generous state benefits, loan forgiveness eligibility,

Qualifications

• RN license required/recognized in OK or via eNLC
• 3 years of professional nursing experience
• Preferred certifications: CCM, CPHQ, CNE, UR/Case Management, CPC/CMC in Medical Coding

Responsibilities

• Provide clinical support to physicians, dentists, and medical staff
• Serve as a clinical specialist to assist medical reviewers and directors
• Develop, review, and maintain medical criteria for the review process
• Act as a liaison between providers and OHCA leadership
• Respond to provider inquiries and communicate with OHCA staff
• Collect data and monitor reports related to Medical Director activities
• Attend meetings/webinars/teleconferences as needed
• Assist with medical coding and billing resources

Job description

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Job Posting Title

Medical Administrative Nurse

Agency

807 HEALTH CARE AUTHORITY

Supervisory Organization

Medical Services

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Full/Part-Time

Full time

Job Type

Regular

Compensation

$78,465/year

Why You’ll Love Working Here

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

Let’s Talk 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.

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $78,465/year

Work Schedule: Monday – Friday

Primary Hours: 8:00 a.m. – 5:00 p.m.

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Medical Administrative Nurse provides clinical support and expert guidance to Medical Directors, Physicians, and other professional staff, ensuring the effective evaluation and review of medical services within the Medicaid division. This role involves researching, developing, and maintaining medical guidelines, assisting with provider inquiries, and supporting medical policy development and review. The Medical Administrative Nurse acts as a liaison between providers and OHCA leadership, supporting the agency’s mission to deliver quality healthcare by ensuring alignment with medical criteria and guidelines while enhancing operational efficiency.

Essential Functions May Include

• Provide clinical support to Physicians, Dentists, and Professional Medical staff.
• Act as a clinical specialist to assist and support physician medical reviewers/medical directors in a variety of tasks.
• Research and gather data, evidence-based reports, or other pertinent information for review of specific medical services with Medical Directors and Medical Consultants.
• Develop, review, revise, and maintain medical criteria and guidelines for use in the medical review process.
• Act as a Medical Review resource for OHCA personnel regarding physician medical review needs and issues.
• Respond to provider inquiries, requests, or other correspondence on behalf of Medical Directors, serving as a liaison between providers and Medical Directors.
• Effectively communicate information from providers to appropriate OHCA staff.
• Collect data, write, and monitor reports related to Medical Director/Medical Reviewer activities.
• Attend meetings, webinars, teleconferences, or other sessions as needed to represent and support Medical Director activities.
• Act as a medical coding resource for the Medical Directors as well as agency staff.
• Act as a billing and claims resolution resource for agency staff as well as providers.
• Work with other Agency departments regarding policy and program issues/concerns related to medical coverage.
• Assist Medical Directors and Physician Consultant staff with any provider request regarding policy or coverage issues.
• Review current medical journals for new pertinent therapies or diagnostic tools and report these to the medical unit for consideration.
• Provide support to managed care SMEs to help answer questions regarding OHCA processes and procedures.
• Other duties as assigned.

Knowledge, Skills, Abilities And Competency Requirements

The Medical Administrative Nurse requires in-depth knowledge of medical guidelines, program administration, and healthcare policy, along with strong analytical skills to assess medical services and support decision-making. Excellent communication and collaboration skills are essential for interacting with providers, Medical Directors, and other stakeholders to ensure compliance and effective operations. Korn Ferry competencies such as Decision Quality and Collaborates align with this role, as it involves making informed judgments on medical cases and fostering cooperation across teams to meet agency goals.

• To be considered for this position your application must include a resume/CV with complete work and education history.**

Education And/or Experience

• 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

• 3 years of professional nursing experience.

Preference Qualifications Include

• Certifications in any of the following areas: Certified Case Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), Certified Nurse Executive (CNE), Certification in Utilization Review or Case Management, Certification in Medical Coding (CPC, CMC, etc.)
• Current and valid Oklahoma Registered Nurse (RN) license
• 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

Physical Demands and Work Environment

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.

Accommodation Statement

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

Notice To Applicants

Please add [e-mail] to the address book or “safe-senders” list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, and disability.

Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.