Compliance Review Manager - PN 20090769 (Medicaid Health Systems Administrator 1)

State of Ohio • Columbus, OH

1d • Onsite

About The Position

The Ohio Department of Medicaid is seeking a Health Systems Administrator to join the Home and Community Based Services (HCBS) Waiver Provider Oversight team in the Network Management Bureau. The role oversees provider compliance with Conditions of Participation for the Ohio Home Care and MyCare Ohio waiver programs. It involves drafting proposed adjudication orders and application denial letters; conducting quality assurance reviews of waiver provider structural reviews for independent providers; analyzing provider performance data to evaluate compliance and identify continuous quality improvement opportunities; responding to inquiries; and collaborating with stakeholders on program operations, compliance activities, and policy implementation. The position is based at 50 West Town Street, Columbus, Ohio, and requires full-time reporting to that work location. Travel may be required as needed, and the employee must provide their own transportation or hold a valid driver's license from their state of residence to operate a state vehicle.

Requirements

• Complete a graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance.
• Have 12 months of experience in delivery of a health services program or health services project management.
• Alternatively, 12 months of experience as a Medicaid Health Systems Specialist (65293) may substitute for the required experience, but not for any mandated licensure.
• If the position oversees assessment or reassessment of clinical appropriateness of services, payment policies, or related Medicaid health services delivery issues, hold a current and valid registered nurse license issued by the Ohio Board of Nursing.
• The equivalent of the stated minimum class qualifications may substitute for the required experience, but not for mandated licensure.
• Provide own transportation for required travel, or have a valid driver's license from the state of residence to operate a state vehicle.

Responsibilities

• Draft proposed adjudication orders and application denial letters.
• Conduct quality assurance reviews of waiver provider structural reviews for independent providers.
• Analyze waiver provider performance data to evaluate compliance and identify opportunities for continuous quality improvement.
• Respond to inquiries from waiver providers, provider advocates, internal ODM staff, and partner state agencies.
• Collaborate with internal and external stakeholders to support waiver program operations, compliance activities, and policy implementation.

Benefits

• Medical coverage.
• Free dental, vision, and basic life insurance premiums after completion of the eligibility period.
• Paid time off, including vacation, personal, and sick leave, plus 11 paid holidays per year.
• Childbirth, adoption, and foster care leave.
• Education and development opportunities, including employee development funds and Public Service Loan Forgiveness.
• Public retirement systems and optional deferred compensation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level