Quality Review Manager (Medicaid Health Systems Administrator 1)
Quality Review Manager (Medicaid Health Systems Administrator 1)
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Job Description
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39) and as outlined in the posting.
Compensation is as listed on the posting unless required by legislation or union contract.
This position is overtime exempt.
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.
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 high-quality person-centric 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.
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 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 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 has Medicaid Health Systems Specialist 65293 may be substituted for the experience required but not for the mandated licensure if required. Note: education & experience is to be commensurate with approved position description on file. -If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03-4723.09 of Ohio Revised Code.
-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required but not for the mandated licensure.
Job Skills: Health Administration
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.
What You Will Do at ODM:
Office: Operations
Bureau: Network Management
Classification: Medicaid Health Systems Administrator 1 (PN)
Job Overview:
Conducting quality reviews of ODM Administered Home and Community Based Waiver Services (e.g. Ohio Home Care) provider structural reviews Drafting Proposed Adjudication Orders and application denial letters Participating in quality reviews of incident investigation Performing data analysis of ODM Administered Home and Community Based Waiver Services (e.g. Ohio Home Care) provider performance measures Responding to inquiries from waiver providers provider advocates internal ODM areas and sister state agencies
Required Experience:
Manager
Employment Type
Full-Time
