THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.
The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.
The goals of the next generation of Ohio Medicaid are:
- 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
- Increase program transparency and accountability
What You Will Do At ODM
Bureau: Health Plan Policy
Classification: Medicaid Health Systems Administrator 1 (PN 20087188 & 20045424)
The Ohio Department of Medicaid (ODM) is seeking two qualified individuals to join ODM’s Hospital Policy Team. The Hospital Policy Team is responsible for the development and implementation of Ohio Administrative Code (OAC) rules, establishing coverage and reimbursement policies, and managing special programs related to hospital services as part of the Ohio Medicaid Program.
The Positions Will Be Responsible For
- drafting new OAC rules, completing revisions to existing OAC rules, managing the rule filing process, and implementing necessary changes across the agency to support the rules
- amending State Plan pages as necessary
- ensuring policies comply with federal & state regulations, rules, and laws
- collaborating with other areas of ODM, sister state agencies, and external stakeholder groups
- responding to inquiries from internal and external stakeholders
Individual Positions Will Be Responsible For
Inpatient Hospital Policy Program Manager (PN 20087188) –
- developing hospital payment & coverage policies related to inpatient hospitals
- developing analysis and models related to hospital franchise fees (HFF), hospital care assurance program (HCAP), and Hospital Additional Payments (HAP)
- evaluating policies related to the regulatory oversight of payments to inpatient hospitals and special programs
- communicating with stakeholders and developing instructional or educational materials to support implementation of inpatient hospital policies and/or MMIS changes
Outpatient Hospital Policy Program Manager (PN 20045424) –
- developing hospital payment & coverage policies related to outpatient hospital and ambulatory surgery centers
- Annual updates to Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes
- developing analysis and models related to care innovation and community improvement program (CICIP) and supplemental payment programs
- evaluating policies related to the regulatory oversight of payments to outpatient hospitals and ambulatory surgery centers
- communicating with stakeholders and developing instructional or educational materials to support implementation of outpatient hospital and ambulatory surgery center programs and policies and/or MMIS changes
Preferred candidates will be detail-oriented, have strong critical thinking and problem-solving skills, the ability to manage multiple priorities, and display great organizational and time management abilities.
What’s In It For You
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
Dental, Vision and Basic Life Insurance
- Dental, vision and basic life insurance premiums are free after one year of continuous service.
Time Away From Work and Work/Life Balance
- Paid time off, including vacation, personal, and sick leave
- 11 paid holidays per year
- Childbirth/Adoption leave
Ohio Public Employees Retirement System
- OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).
Or 12 months experience as a Medicaid Health Systems Specialist, 65293.
Note: education & experience is to be commensurate with approved position description on file.
Or equivalent of Minimum Class Qualifications for Employment noted above.
United States of America-OHIO-Franklin County-Columbus
Ohio Department of Medicaid
Bargaining Unit / Exempt
8:00AM – 5:00PM
Agency Contact Information
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