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 pricing, 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,
customer 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