The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.
Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.
A program that puts the individual first
Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.
- Emphasize a personalized care experience,
- Improve care for children and adults with complex behavioral health needs,
- Improve wellness and health outcomes,
- Support providers in better patient care and
- Increase program transparency and accountability.
Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.
Office: Health Innovation & Quality
Bureau: Clinical Operations
Working Title: Medicaid Health Systems Specialist (RN) (PN:20043101)
- As a Compliance & Safety Check Nurse/Reviewer, this position requires travel throughout Ohio, some of which will include overnight stays. ***
This position will be temporarily working/teleworking from home and will be expected to return to the office in Columbus once normal business operations are resumed.
As the Compliance & Safety Check Nurse/Reviewer in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include
This position is headquartered in Franklin County.
- Conducting compliance and safety check surveys, many of which occur in the consumer’s home
- Conducting oversight activity to include medical & programmatic document review & face to face (e.g., may be conducted on-site) assessments &/or reassessment (e.g., questionnaires & documents to review programs) & all oversight activity of all Medicaid programs (e.g., PACE, PASSARR, Waiver) administered by other state agencies (e.g., Ohio Department of Education [ODE], Ohio Department of Health [ODH], Mental Health and Addiction Services [OMHAS], Ohio Department of Youth Services [ODYS], Ohio Department of Aging [ODA], Ohio Department of Developmental Disabilities [DODD]) & ODM Ohio Home Care/State Plan, Managed Care
- Reviewing & evaluating medical & programmatic documents developed by contractors, county boards & providers to determine quality assurance of health & safety & clinical &/or programmatic appropriateness of services &/or payment policies.
As the Compliance and Safety Check Nurse/Reviewer, you will be required to possess a current and valid license to practice professional Nursing as a Registered Nurse (RN) in Ohio as issued by the Board of Nursing in order to conduct
compliance and safety check surveys of Ohio’s Medicaid consumers.
Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing.
Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.
United States of America-OHIO-Franklin County-Columbus
Ohio Department of Medicaid
Bargaining Unit / Exempt
8:00 a.m. – 5:00 p.m.
Agency Contact Information
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About the company
Hospital & Health Care 501-1,000 employees 296 on LinkedIn
Becoming a cabinet-level agency in 2013, the Ohio Department of Medicaid (ODM) delivers health care coverage to more than three million residents of Ohio on a daily basis.
Working closely with stakeholders, advocates, medical professionals, and fellow state agencies, the agency continues to find new ways to modernize Medicaid in Ohio.
Some recent accomplishments include:
• enhancing investment in home-based and community-based setting for long-term care
• implementing a new Medicaid managed care program that brings a new level of choice to residents across Ohio
launching a comprehensive primary care (CPC) program to pay for value rather than volume
• integrate physical and behavioral health care and enhance the quality of care delivered to Ohioans through the Behavioral Health Redesign
We are dedicated to being a national leader in health care coverage innovation that improves the lives of Ohioans and strengthens families.
If you have any questions about Ohio Medicaid covered services, call 800-324-8680. …
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