Managed Care Policy Administrator
4 weeks ago
THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS
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 DeWine's agenda for Ohio's 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 governor's 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.
What You Will Do At ODM:
Office: Managed Care
Bureau: Managed Care Compliance & Oversight
Classification: Medicaid Health Systems Administrator 2 (PN 20047486)
Job Overview:
As the Managed Care Policy Administrator in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities may include:
* Planning, managing, evaluating, and implementing policies related to enrollment of individuals in Medicaid Managed Care programs as it relates to Next Generation Managed Care implementation
* Implementing Medicaid State Plan Amendments (SPA) and Ohio Administrative Code (OAC) rule changes, changes to managed care enrolled populations
* Developing pharmacy policy, provider agreement amendments, administrative rules, federal authorities, and guidance memorandums for Managed Care Plans
* Assisting in providing strategic oversight of policies and procedures governing Medicaid managed care
* Ensuring that managed care program policies and procedures comply with federal and state regulations by researching applicable regulations and working with appropriate ODM staff, federal and state agencies
* Assisting higher level administrators in development and coordination of overall programs relating to Medicaid health delivery systems and contacting managed care plans
* Explaining eligibility and enrollment in Managed Care Plans (MCPs) to individuals and stakeholders
* Research legislative inquiries utilizing state and federal regulations, contracts, and policy guidance
* Act as administrator for outward facing communication solutions
What's in it for you:
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
* Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans.
Dental, Vision and Basic Life Insurance
* Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.
Time Away From Work and Work/Life Balance
* Paid time off, including vacation, personal, and sick leave
* 11 paid holidays per year
* Childbirth/Adoption leave
Employee Development Funds
* The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.
Ohio Public Employees Retirement System
* OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee's salary. Visit the OPERS website for more information.
Deferred Compensation
* The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
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, Interpreting Data, Leading Others, Managing Meetings, Motivating Others, Verbal Communication, Written Communication
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