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.
Working Title: Provider Engagement Specialist
Classification: Medicaid Health Systems Specialist (PN 20046417)
Bureau: Business Operational Support, Provider Relations
As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:
- Resolve institutional provider complaints submitted through HealthTrack; ensure Managed Care Organizations (MCOs), MyCare, and OhioRISE are meeting provider agreement requirements
- Assist with oversight of the Claims Payment Systemic Errors for MCOs and OhioRISE
- Participate in Provider Advisory Council (PAC) meetings, review PAC reports, ensure the needs of our providers are met
- Assist with oversight of the MCO and OhioRISE provider representative requirement
- Research and resolve managed care provider claim inquiries
- Respond to escalated fee-for-service (FFS) institutional provider claim inquiries
- Conduct institutional FFS provider consultations as needed
- Attend meetings and seminars, deliver presentations, and create training material
- Collaborate with internal and external stakeholders across departments and levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement and the health care delivery system
Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.
- Or 24 months experience as Medicaid Health Systems Analyst, (65291).
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required.
United States of America-OHIO-Franklin County-Columbus
Ohio Department of Medicaid
Bargaining Unit / Exempt
8:00 a.m. – 5:00 p.m.
Feb 8, 2022, 11:59:00 PM
Agency Contact Information
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