Qualified Clinical Reviewer & Program Coordinator (Medical Review Coordinator)

Initial Posting Date:

08/04/2026

Application Deadline:

08/18/2026

Agency:

Oregon Health Authority

Salary Range:

$7,347 - $11,152

Position Type:

Employee

Position Title:

Qualified Clinical Reviewer & Program Coordinator (Medical Review Coordinator)

Job Description:

If this opportunity aligns with your strengths, background, and commitment to fostering inclusivity, we encourage you to apply! At the Oregon Health Authority (OHA), we value diversity and encourage applicants from all backgrounds and experiences to help us build a stronger, more equitable future for all.

Opportunity Awaits, Apply Today! – Qualified Clinical Reviewer & Program Coordinator (Medical Review Coordinator)

We have 15 positions to be filled incrementally over the next 6 months. 8 positions are slotted for our first round of onboarding.

The Provider Clinical Support Services unit within the Oregon Health Authority's Medicaid Division supports Oregon Health Plan (OHP) Fee-for-Service (FFS) utilization management by ensuring members receive clinically appropriate, medically necessary, and policy-compliant health care services. The unit provides clinical expertise for prior authorization reviews, claims determinations, Medical Management Committee reviews, provider consultation, administrative hearings, and Oregon Administrative Rule (OAR) development. The team works closely with health care providers, Coordinated Care Organizations (CCOs), and internal agency partners to promote equitable access to medically necessary services while supporting high-quality clinical decision-making across the Medicaid program. 

The Qualified Clinical Reviewer & Program Coordinator serves as a clinical authority responsible for reviewing complex medical documentation, interpreting clinical policy, and making evidence-based determinations that directly impact Oregon Health Plan members' access to care. In this position, you will conduct prior authorization and claims reviews, provide consultation to providers and agency staff, support the Medical Management Committee, serve as an expert witness during administrative hearings, and contribute to policy development, quality improvement, and program oversight. You will also monitor clinical trends, evaluate program effectiveness, collaborate with healthcare partners to improve continuity of care, and help ensure Medicaid services are delivered consistently, equitably, and in compliance with state and federal requirements. 

It will be your responsibility and privilege to factor in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized. 

For a full review of the position description, please click here.

What We Are Looking For

Minimum Qualifications: These qualifications must be reflected in your application for consideration.

A current Registered Professional Nurse license issued by the Oregon State Board of Nursing at the time of appointment and maintained throughout employment AND three years of nursing experience that includes review of medical records.

Desired Attributes: The following are desired attributes that we have identified as key to success for this role at OHA. These are the attributes we are looking for in