|Department||Health Care Authority|
|Date Opened||2/10/2020 08:00:00 AM|
|Filing Deadline||2/24/2020 11:59:00 PM|
|Full or Part Time||
POSITION PURPOSE: PREFERENCE MAY BE GIVEN TO APPLICANTS WITH:
Under the direction of the Director this position will provide clinical support to the 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 including: communication with providers, medical review and assist with general medical director responsibilities. This employee will interface with providers, legislative representative and OHCA staff to facilitate medically appropriate care for members and appropriate responses to provider requests. Assist Medical Directors, Medical Consultants, Dentists and Director in maintaining open communications with all areas within the agency.
*Research and gather data, evidence based reports or other pertinent information for review of specific medical services with Medical Director and Medical Consultants.
*Develop, review, revise and maintain medical criteria and guidelines for use in the medical review process.
*Act as Medical Review resource for OHCA personnel regarding physician medical review needs and issues.
*Respond to provider inquiries, request or other correspondence on behalf of Medical Directors, i.e. serve as 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.
*May authorize medical services to members, and under the supervision and direction of a Medical Director, may deny services.
*Authorize payment for provider services, and under the supervision and guidance of a Medical Director, may deny payment for provider services.
*Work with other Agency departments regarding policy and program issues/concerns related to medical coverage.
*Work with internal QA processes/personnel to monitor authorization process and program adherence to state and federal guidelines and contracts.
*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.
*Act as a medical coding resource for the Medical Directors as well as agency staff.
*Other duties as assigned.
EDUCATION AND/OR EXPERIENCE:
Bachelor’s degree in Nursing AND RN (with current valid license as Registered Nurse in Oklahoma) AND At least three (3) years of full-time professional clinical experience in an acute care setting
Nurse must maintain a valid license for the duration of employment
*Certified Professional Coder
*Certified Professional Medical Auditor
*Utilization Review experience
*Medical authorization experience
*Medicaid (especially SoonerCare) experience
PREFERENCE MAY BE GIVEN TO APPLICANTS WITH:
The Oklahoma Health Care Authority complies with applicable 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.
Veteran’s preference points apply only for initial appointment in the classified service.