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
They Are
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: Managed Care
Bureau: Policy & Program Development
Classification: Medicaid Health Systems Administrator 1 (PN 20047489)
Job Overview
Under general direction, serves as agency manager of Medicaid program(s) &/or initiatives to research, analyze and evaluate one statewide component of Medicaid Health systems (e.g., managed care policy and analysis development): plans, manages, researches, evaluates and analyzes policies related to the regulatory oversight of Medicaid managed care programs (e.g., investigates and clarifies benefits for consumers enrolled in managed care plans (MCPs); analyzes data collected from MCPs or providers); performs policy, provider agreement and request for proposals (RFP) development; assist in providing strategic oversight of policies and procedures governing Medicaid managed care; ensures that managed care program policies and procedures comply with federal and state regulations by researching applicable regulations and working with appropriate staff, federal and state agencies; assists higher level administrators in development and coordination of overall programs relating to Medicaid health delivery systems and contacting managed care plans; formulates policy & recommends legislative and programmatic changes. Convenes, facilitates and responds to stakeholder groups on behalf of managed care program design and implementation.
Coordinates development of policies, procedures and/or rules; reviews and provides analysis of federal notices and state clearances; develops provider agreement and rule language; coordinates review, preparation, clearance and filing of program rules, manuals and/or handbooks; tracks and responds to legislative inquiries, provider and/or consumer complaints; serves as liaison with Bureau of State Hearings to coordinate MCP representation, review, prepare and track outcomes of state hearings and MCP compliance actions and/or serves as a liasion with other state agencies as needed; provides technical assistance to managerial and supervisory personnel involved in the implementation of new projects; informs bureau staff and MCPs regarding proposed managed care policy changes; provides technical assistance to staff; MCPs and providers; testifies at legislative or public hearings; assists other areas in the bureau as assigned.
Prepares comprehensive written reports summarizing findings and recommendations of program policies; coordinates the processing of provider agreements and administrative rules; maintains unit/team program reports, documentation, proposed legislation and/or agency rules; develops monitoring and evaluation systems for contracted MCPs; manages oversight of records maintenance and the quality review process for records retention; operates personal computer and applicable software applications to create, store and retrieve correspondence and/or generate reports and/or spreadsheets; delivers speeches to the public (e.g., MCPs, community groups).
Performs other related duties (e.g., attends staff meetings and training; maintains records, logs and files; travels to meeting sites).
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.
Primary Location
United States of America-OHIO-Franklin County-Columbus
Work Locations
Lazarus 4
Organization
Ohio Department of Medicaid
Classified Indicator
Classified
Bargaining Unit / Exempt
Exempt
Schedule
Full-time
Work Hours
8:00AM – 5:00PM
Compensation
$32.71/hour
Unposting Date
Jun 23, 2021, 3:59:00 AM
Job Function
Health Administration
Job Level
Individual Contributor
Agency Contact Information
HumanResources@medicaid.ohio.gov