Provider Network and Data Oversight Specialist (Health Services Policy Specialist)
Provider Network and Data Oversight Specialist (Health Services Policy Specialist)
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Job Description
What You Will Do At ODM:
Office:Managed Care
Bureau: Managed CareCompliance &Oversight
Classification: Health Services Policy Specialist(PN: )
Job Overview:
As Provider Network and Data Oversight Specialist your will be responsible to:
- Lead for managed care provider data management and provider network standard methodologies
- Manage provider network reportingfor managed care organizations (MCOs)/ MyCare Ohio plans (MCOP)
- Assist with oversight of provider network management (PNM) module for Managed Care
- Assist in communication of data
- MCO/ MCOP provider enrollment liaison
- MCO/ MCOP lead for the managed care network provider reconciliation files
- Monitor Provider Agreement (PA)/ Code of Federal Regulations (CFR) Compliance
- Monitor and review MCO/ MCOP directories for compliance with PA (data specifically)
About Us:
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWines agenda for Ohios future. To ensure Ohio is the best place to live work raise and family and start a business we must have strong schools a great quality of life and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governors vision. As the single state Medicaid agency responsible for administering highquality personcentric healthcare the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
Delivering a personalized care experience to more than three million people served.
Improving care for children and adults with complex behavioral health needs.
Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
Ensuring financial transparency and operational accountability across all Medicaid programs and services.
The State of Ohio is a drugfree workplace which prohibits the use of marijuana (recreational marijuana/nonmedical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio DrugFree Workplace Policy (HR39) and as outlined in the posting.
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 fulltime and parttime employees*. For a list of all the State of Ohio Benefits visit ourTotal Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off including vacation personal sick leave and 11 paid holidays per year
- Childbirth Adoption and Foster Care leave
- Education and Development Opportunities (Employee Development Funds Public Service Loan Forgiveness and more)
- Public Retirement Systems (such as OPERS STRS SERS and HPRS)&Optional Deferred Compensation (Ohio Deferred Compensation)
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
Completion of graduate core coursework in health services administration mathematics statistics actuarial science public administration allied health sciences nursing economics or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology measurement & testing analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases use of computer hardware software used for spreadsheets statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
Or completion of undergraduate core coursework & 12 mos. exp. in one of following: health services administration mathematics statistics actuarial science public administration allied health sciences nursing economics public health or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology measurement & testing analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases use of computer hardware software used for spreadsheets statistical analysis graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
Or 2 yrs. exp. as Health Services Analyst 65211.
Or equivalent of Minimum Class Qualifications For Employment noted above.
Job Skills: Data Analytics
Technical Skills: Health Administration Data Modeling Data Visualization
Professional Skills: Analyzation Attention to Detail Collaboration Innovation
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.
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 drivers license from state of residence.
Resumes and/or attachments are not reviewed. Therefore please provide detail in the work experience section of your application.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
