Oklahoma Health Care Authority (OHCA) seeking Medical Review Nurse III – Suspended Claims


We Are Hiring

The Oklahoma Health Care Authority (OHCA) is the State Medicaid Agency of the State of Oklahoma. OHCA is searching for the following:
Medical Review Nurse III – Suspended Claims

The Medical Review Nurse will act as the clinical reviewer of the highest and most complex cases (through 
claims reviews).
This could include, but is not limited to, complex Caesarean Section (C/S), manual pric
ing, and Genetic testing claims.
These are reviewed in a retrospective claim scenario.
Responsibilities in
clude: reviewing documentation, evaluating claim processing, research and respond to provider,
service and provider representatives, as well as making recommendations.

Requires the following:

•A valid RN license 
AND 3 years of clinical experience, including experience in health care monitoring
(e.g., quality 
assurance, surveillance and utilization review, auditing, health policy), clinical coding, and reimbursement, clinical review of claims and claims auditing.
• Experience using database applications. 

• Certified Professional Coder (CPC) certification preferred.

•Advanced health related education, Medicaid, managed care, coding, utilization, policy, and/or quality assurance/improvement is also preferred.

Apply at: www.okhca.org

Closing Deadline: 10.29.2021