The Oregon Health Authority has a fantastic opportunity for a Registered Nurse with strong medical records experience to join an excellent team, provide integral medical reviews and work to advance their Medicaid operations.
This position falls under the Classification Medical Review Coordinator.
WHAT YOU WILL DO!
The mission of the Oregon Health Authority (OHA) Fiscal and Operations Divisions/ Office for Program Integrity/ Program Integrity Audit Unit is to ensure program integrity of the Medicaid programs.
As a Medical Review Coordinator, you will perform an integral function conducting compliance audit of providers and contractors participating in programs for OHA and the Department of Human Services (DHS).
In this role, you will apply medical expertise in auditing the most complex provider records using applicable state, federal and OHA/DHS rules. You will support Program Integrity mandates, by performing audits that examine the medical necessity of Medicaid and Medi-Medi services. You will consult with the Medical Director, physicians, and other medical providers about various complex diagnostic issues and procedure codes, to accurately and properly audit providers or contractors. You will also support an entire operation by providing licensed medical necessity guidance and subject matter expertise.
The audit function in Program Integrity is designed to deter medical program fraud and abuse, and to monitor and ensure provider and contractor compliance with Federal, State, and Agency rules and regulations.
WHAT WE ARE LOOKING FOR:
WHAT’S IN IT FOR YOU?
We offer a workplace that balances productivity with enjoyment; promote an atmosphere of mutual respect, dedication, and enthusiasm. You will collaborate in an open office with a team of bright individuals to work with and learn from. We offer full medical, vision and dental with paid sick leave, vacation, personal leave and ten paid holidays per year plus pension and retirement plans. If you're driven by the passion to do something meaningful that changes lives, the Oregon Health Authority is the place for you.
This is a full-time, permanent position that is classified and represented by SEIU.
The Oregon Health Authority is committed to developing and promoting culturally and linguistically appropriate programs and a diverse and inclusive workforce representing the diversity, culture, strengths and values of the people of Oregon. Click here, to learn more about OHA’s mission, vision and core values. OHA is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, genetic information or any other protected class under state or federal law.
The Oregon Health Authority is modernizing and expanding their IT infrastructure and currently has a fantastic opportunity for a Project Manager with IT experience to join an excellent team and work to advance their IT operations.
What you will do:
As a Senior IT Project Manager, you will develop and manage the execution of comprehensive or high-risk project plans, budgets, schedules and controls from project initiation to project close-out.
This position offers you the opportunity to lead the decision-making process throughout the Oregon Health Authority and Department of Human Services for the detailed requirements, design, testing and start-up operations related to the development and implementation efforts of achieving the long term goals of the customer agency.
What's in it for you?
Collaboration in an open office with a team of bright individuals to work with and learn from. We offer full medical, vision and dental with paid sick leave, vacation, personal leave and ten paid holidays per year. If you are a Project Manager with IT experience, don't delay, apply today!
MINIMUM QUALIFICATIONS:
Seven years of professional project management experience that included leading and managing discrete projects from initiation and planning through closure and evaluation.
OR
An Oregon Project Management Associate Certification or Project Management Professional Certification awarded by the Project Management Institute AND six years professional project management experience that included leading and managing discrete projects from initiation and planning through to closure and evaluation.
A Bachelor's degree in Business Administration, Management, Public Administration or a closely related field may substitute for three years of the experience. An advanced degree may substitute for an additional year of experience.
REQUESTED SKILLS:
TO APPLY:
Please follow the link below to submit an application.