• Job Description

  Req#: 2500057T

  What You Will Do At ODM:

  Office: Managed Care

  Bureau: Contract Management & Compliance

  Classification : Medicaid Health Systems Administrator 2 (PN: 20102111 )

  Job Overview :

  As the Managed Care Administrator in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

  • Supervising grievance and appeal coordinator staff & special projects/MCE access staff
  • Assuring accurate reporting of plan grievances and appeals into ODM systems
  • Assuring accurate reporting of MCE prior authorization data
  • Developing and maintaining applicable reporting for compliance and oversight
  • Developing appropriate policies and procedures for staff
  • Leading a team and working independently to conduct complex analysis of programmatic data in order to monitor the MCPs for compliance.
  • Determining and developing key indicators that will have systematic impact on improving MCPs performance by performing ongoing analysis of data and healthcare related issues and developing summary reports.
  • Advising section chief by summarizing findings and recommendations, resulting from data analysis and recommending interventions related to improving MCP performance.
  • Acting as liaison to both intra-agency and inter-agency providers (e.g. MCPs, Bureau of State Hearings, etc.).
  • Assisting the section chief with developing policies and procedures related to MCPs appeals, grievances and state hearings.
  • Participating in developing business requirements for obtaining a new data system for appeals and grievances, as part of an internal workgroup.

  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

  Professional Skills: Critical Thinking, Collaboration, Attention to Detail, Goal Setting, Managing Meetings, Organizing and Planning, Decision Making, Verbal Communication, Written Communication

• 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.

Notice