Medical Administrative Nurse

Oklahoma AG; Oklahoma City (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

Oklahoma Health Care Authority (OHCA) seeks a Medical Administrative Nurse to provide clinical support, develop medical criteria, and assist with policy and provider inquiries within the Medicaid division. You will liaison between providers and OHCA leadership to ensure guideline alignment and efficient operations.

The role requires an Oklahoma RN license and 3 years of professional nursing experience, with opportunities for advanced certifications and professional development.

Qualifications

• Possession of a valid permanent Oklahoma RN license is required.
• 3 years of professional nursing experience preferred.
• Certifications in case management or healthcare quality are a plus.

Responsibilities

• Provide clinical support to Medical Directors, Physicians, and staff.
• Develop and maintain medical criteria and guidelines for medical review.
• Assist with provider inquiries and policy development.
• Act as a liaison between providers and OHCA leadership.

Job description

## Medical Administrative NurseApply: Oklahoma County: Full time: Posted Today: End Date: September 27, 2026 (15 days left to apply): JR65127**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.**Estimated Appointment End Date (Continuous if 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**We know your great work deserves great support. Here’s a snapshot of what we offer for all eligible employees.* 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 ManagementorHealthcare 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.