Health Care Management Nurse III

Location: Northern

## Health Care Management Nurse IIIApply:
Oklahoma County:
Full time:
Posted Yesterday:
End Date:
October 2, 2026 (11 days left to apply):
JR65537
** Job Posting Title
** Health Care Management Nurse III
** Agency
* * 807 HEALTH CARE AUTHORITY
** Supervisory Organization
** Medical Guidelines
** Job Posting End Date
** Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note:

Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
** Estimated Appointment End Date (Continuous if Blank)
**** Full/Part-Time
** Full time
** Job Type
** Regular
* * Compensation**$84,990/year
** Why You’ll Love Working Here
** At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values,
** Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership**, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.
** Let’s Talk Benefits
** We know your great work deserves great support. Here’s a snapshot of what we offer for all eligible employees.
* Generous state-paid benefit allowance to offset insurance premiums.
* A wide selection of insurance plans with no pre-existing condition exclusions.
* Flexible Spending Accounts for health care and dependent care.
* Retirement Savings Plan with employer contributions.
* 11 paid holidays annually.
* 15 days of vacation and 15 days of sick leave in the first year.
* Longevity Bonus recognizing years of public service.
* Public Service Loan Forgiveness eligibility and tuition reimbursement.
* Wellness benefits, including an on-site gym and fitness center discounts.
** Job Description
***
* Location:

** 4345 N Lincoln Blvd, Oklahoma City, OK 73105
** Salary:** $84,990/year
*
* Work Schedule:

** Monday – Friday
** Primary

Hours:

** 8:00 a.m. – 5:00 p.m.#
** Agency/Division Information
** The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.#

** Position

Purpose:

** The Health Care Management Nurse III is responsible for overseeing case management processes, analyzing data for potential fraud, waste, and abuse, ensuring compliance with HIPAA and organizational policies, conducting provider audits, and managing second-level appeals. This role involves close coordination with medical directors, legal teams, and other healthcare professionals to ensure the accuracy, professionalism, and efficiency of health care management operations.#

** Essential Functions May Include:
*** Monitor the HCMU Medical box in Aerial, complete reviews, and upload documents in a timely manner. Coordinate exception requests, communicate outcomes with patients and providers, and participate in pharmacy and medical appeals.
* Protect the privacy and confidentiality of program participants' information, undergo annual HIPAA training, and review compliance programs with employees under direct supervision.
* Conduct clinical record audits to ensure provider compliance with the Health Choice plan, prepare detailed reports, and communicate findings with providers and senior leadership.
* Review and assist in making fair determinations on second-level appeals in collaboration with the CMO and other healthcare professionals.
* Other duties as assigned.#
** Knowledge, Skills, Abilities and…