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MAR Supervisor - Prior Authorizations The State of Oklahoma - Oklahoma City, OK

Company: The State of Oklahoma
Location: Oklahoma City
Posted on: January 13, 2022

Job Description:



MAR Supervisor - Prior Authorizations

Recruitment #210614-UNCY-157



Department
Oklahoma Health Care Authority





County Location
Oklahoma OK







Date Opened
6/14/2021 08:00:00 AM





Filing Deadline
6/28/2021 11:59:00 PM





Salary
$71,314.00/year





Full or Part Time
Full-Time








INTRODUCTION




POSITION PURPOSE:


Act in coordination with Medical Authorization and Review Director for oversight and supervision of the prior authorization (PA) review process and PA review staff. This would include the coordination and supervision of PA reviews for medical necessity. Act as a supervisor to both medical and non-medical staff.


PRINCIPLE ACTIVITIES:

*Oversee authorization of identified medical services within the scope of the Oklahoma Medicaid program and state and federal regulations. Ensure that the PA review process is efficient, timely, and responsive to providers' and members' needs


  • Coordinates the development of new policy and/or changes to existing policy and makes recommendations based on current clinical guidelines.

  • Coordinate PA review process for medical services and ensure that PA reviews are processed appropriately and within Agency and Unit timeframes.
  • Ensure that all PA review procedures are standardized and applied consistently. Monitor and review MAR activities for adequate documentation, appropriate approval/denial process adherence and meet timely processing guidelines.
  • Ensure timely staff response to inquiries regarding scope of the Oklahoma Medicaid program stakeholders, including Providers and internal Agency staff.

  • Coordinate training for PA review staff regarding duties they are directed to perform. Including any revisions to Oklahoma Medicaid program related to new medical services and/or codes that are chosen to be opened and PA'd for review.

  • Coordinate and collaborate with other OHCA departments such as Provider Services and Finance. Work with Agency staff to develop and assist with training and respond to provider inquiries related to PAs and any related issues or questions.
  • Collect data, write and monitor monthly reports for trends regarding PA process. Identify opportunities for process improvement. Ensure timely submission for required division, agency, state and federal reporting mechanisms.
  • Collaborate with other Agency departments regarding policy and issues/concerns related to PA review process to identify and clarify potential program coverage issues.
  • Coordinate internal QA processes with Senior Medical Director to monitor staff for appropriate determinations made with the use of OHCA policy, Unit guidelines, state and federal guidelines.
  • Represent OHCA as needed in various public forums involving stakeholder groups, as well as informational seminars and training forums.

  • Performs special projects as required.
  • Other duties as assigned.




    SUPERVISORY RESPONSIBILITIES:


    This job has supervisory responsibilities, as assigned, including interviewing and training Medical Authorization and Review staff; planning, assigning and monitoring work/referrals; appraising staff work performance; disciplinary measures; addressing staff complaints and resolving personnel issues.



    EDUCATION AND EXPERIENCE:



    • 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 AND

    • At least one (1) year experience as a Quality Assurance/Utilization Review Nurse




      PREFERENCE MAY BE GIVEN TO APPLICANTS WITH:


      *Bachelor's degree in Nursing


      • Medicaid experience (especially SoonerCare experience)

      • Management/supervisory experience

      • Prior authorization experience



        Accommodation Statement:


        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 .

        CONCLUSION
        Veteran's preference points apply only for initial appointment in the classified service.



Keywords: The State of Oklahoma, Oklahoma City , MAR Supervisor - Prior Authorizations The State of Oklahoma - Oklahoma City, OK, Other , Oklahoma City, Oklahoma

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