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HYBRYD - Provider Network and Data Oversight Specialist (Health Services Policy Specialist)

2 months ago

Columbus, United States Ohio Department of Aging Full time
What You Will Do At ODM:

Office : Managed Care

Bureau : Managed Care Compliance & Oversight

Classification: Health Services Policy Specialist (PN : 20102013 )

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 reporting for 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)


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
  • 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.

Qualifications

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