• Job Description

  Req#: 97975
  
  Lazarus 5 (MCDLZ5)
  50 West Town Street
  Columbus, 43215
  
  !*!

  THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.

  About Us:

  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:

  Office: Health Innovation & Quality

  Bureau: Health Research & Quality

  Classification: Medicaid Health Systems Administrator 2 (PN:20101210)

  Job Overview:

  The Ohio Department of Medicaid (ODM) is seeking an experienced professional to oversee implementation of external quality review program requirements for Ohio’s Medicaid Managed Care Programs (e.g., Managed Care, MyCare Ohio, OhioRISE, and the Single Pharmacy Benefit Manager). The External Quality Review (EQR) process is designed to improve ODM’s ability to monitor the Managed Care Entities and help them improve their performance with respect to quality, timeliness and access to care; achieving higher performing managed care delivery systems for Ohioans. As the External Quality Review Administrator, your responsibilities will include:

  • Developing external quality review program policies and procedures that both comply with federal regulations and support ODM’s Managed Care Quality Strategy
  • Leading intra-agency teams in the development and implementation of external quality review activities
  • Analyzing and interpreting federal and state regulations, rules and laws to ensure program compliance
  • Monitoring ODM’s selected external quality review vendor to assure work products comply with federal EQR regulations and meet ODM’s operational needs
  • Serving as the agency manager for Ohio Medicaid accreditation requirements
  • Leading meetings and presentations with both internal and external stakeholders
  • Representing the agency in workgroups

  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:

  Medical Coverage

  • Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans.

  Dental, Vision and Basic Life Insurance

  • Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.

  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

  Employee Development Funds

  • The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.

  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.

  Deferred Compensation

  • 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; 24 mos. exp. in planning & administering 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 analysis).
  
  -Or 24 months experience as a Medicaid Health Systems Administrator 1, 65295. Note: education & experience is to be commensurate with approved position description on file.
  
  -Or equivalent of Minimum Class Qualifications for Employment noted above.
  
  Technical Skills: Health Administration, Policy Direction, Planning and Development

  Professional Skills: Collaboration, Leading Others, Organizing and Planning, Performance Management

  !*!

  Supplemental Information:

  Compensation is as listed on the posting unless required by legislation or union contract.

  Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

  Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

  Ohio is a Disability Inclusion State and strives to be a Model Employer of Individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

  !*!

  The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.

• About the company

  Ohio is a state in the Midwestern region of the United States. Of the fifty states, it is the 34th-largest by area, and with a population of nearly 11.8 million, is the seventh-most populous and tenth-most densely populated.

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