Medical Administrative Nurse

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

Benefits offered by this job

State-paid benefit allowance

Insurance plans with no pre-existing条件

Job summary

The Oklahoma Health Care Authority (OHCA) seeks a Medical Administrative Nurse to provide clinical support to Medical Directors, Physicians, and other professional staff within the Medicaid division. You will help evaluate and review medical services, researching and maintaining medical guidelines, and assisting with provider inquiries to ensure policy alignment.

This role acts as a liaison between providers and OHCA leadership, supporting policy development and operational efficiency.

Qualifications

• Experience with medical guidelines and policy development.
• Ability to liaise between Medical Directors, Physicians, and OHCA staff.
• Strong data gathering and evidence-based reporting skills.

Responsibilities

• Provide clinical support to Physicians, Dentists, and Professional Medical staff.
• Act as a clinical specialist to assist physician medical reviewers/medical directors.
• Research and gather data and evidence-based reports for review of medical services.
• 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 on behalf of Medical Directors, serving as a liaison between providers and OHCA.
• Collect data, write, and monitor reports related to Medical Director/Medical Reviewer activities.
• Attend meetings and webinars to represent and support Medical Director activities.
• Provide medical coding and billing/claims resolution guidance for agency staff and providers.
• Collaborate with policy and program teams on coverage issues.

Skills

Clinical support

Medical guidelines

Analytical skills

Communication

Collaboration

Job description

Medical Administrative Nurse

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.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

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 hea l th 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 Competenc y 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 essen