Job Details

Qualified Clinical Reviewer & Program Coordinator

Oregon Health Authority, Salem, OR

Job - Government

Close Date: 06/30/2019

Are you a registered nurse with clinical experience? Does your nursing experience include review of medical records?

The Oregon Health Authority – Health Systems Division is seeking to hire three Qualified Clinical Reviewer and Program Coordinator (Medical Review Coordinator). These positions are required to meet the business need of the Health Systems Division (HSD) and Provider Clinical Support Unit to evaluate and process requests for prior authorizations of medical services, and other related activities for fee-for-service Medicaid members in Oregon.

This recruitment may be used to fill future vacancies.


These positions have direct impact on public health and welfare by authorizing direct medical services to be provided by contracted Medicaid providers in Oregon for patients in the fee-for- service category but does not evaluate requests for those enrolled in Oregon's Coordinated Care Organizations. Health care services ranging from laboratory assessments, imaging, physical and occupational therapy, speech therapy, durable medical equipment, hearing aids, and requests for births outside a hospital require prior authorization in conformity to the Prioritized List from the Health Evidence Review Commission.

The demands of these positions require regular daily attendance on the premises from 8:00 am to 5:00 pm and extensive use of computers and telephones by nature of the job.

What we are looking for!

Possession of a valid registered professional nursing license at the time of appointment and maintenance of a current Oregon licensure. ANDThree (3) years of nursing experience that includes review of medical records is required. Preference may be given to those who possess a bachelor’s degree in nursing (BSN).
Experience working as a professional with a medical facility providing direct patient services.
Experience interpreting medical records.
Understanding CPT Procedure coding and ICD-10 diagnoses.
Demonstrated experience effectively communicating in written and verbal forms.
Willingness to declare conflict of interest.
Demonstrated attendance history of meeting the demands of the work/position.
Experience creating and maintaining a work environment that is respectful and accepting of diversity among team members and the people we serve.


Complete details: https://oregon.wd5.myworkdayjobs.com/en-US/SOR_External_Career_Site/job/Salem--Summer-Street---OHA/Qualified-Clinical-Reviewer---Program-Coordinator_REQ-11047