MAR Supervisor - Prior Authorizations The State of Oklahoma - Oklahoma City, OK
Company: The State of Oklahoma
Location: Oklahoma City
Posted on: January 13, 2022
MAR Supervisor - Prior Authorizations
Oklahoma Health Care Authority
6/14/2021 08:00:00 AM
6/28/2021 11:59:00 PM
Full or Part Time
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.
*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
- Coordinate PA review process for medical services and ensure
that PA reviews are processed appropriately and within Agency and
- 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
- Represent OHCA as needed in various public forums involving
stakeholder groups, as well as informational seminars and training
- Performs special projects as required.
- Other duties as assigned.
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
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 .
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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