Disability Determination Nurse (Medicaid Health Systems Specialist RN)

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.

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.

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.

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 applicants prior criminal convictions will be made before excluding an applicant from consideration.

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.

Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. nursing.

-Or for positions other than those requiring valid license as registered nurse completion of undergraduate core program in business administration social or behavioral science health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.

-Or for positions other than those requiring valid license as registered nurse 24 months experience as Medicaid Health Systems Analyst (65291) may be substituted for the experience required but not for the mandated licensure.

-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

What You Will Do at ODM:

Office:Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN )

Job Overview:

The Registered Nurse (RN) in this position will:

• Utilize the Ohio Administrative Code (OAC) and Federal rules policies and procedures to make clinical/medical based definitive decisions to determine disability
• Review and evaluate medical records and statistical reports
• Frequently use electronic medical documentation and software applications interact with providers other agencies and external stakeholders

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.