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 [email protected]  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.

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

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