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

State of Ohio • Columbus, OH

2d • 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 Bureau of Network Management. The role oversees provider compliance with Conditions of Participation for the Ohio Home Care and MyCare Ohio waiver programs. The ideal candidate is detail-oriented and analytical, applies critical thinking and data-driven decision-making to complex challenges, delivers accurate, high-quality results, manages competing priorities, communicates effectively, collaborates with diverse stakeholders, and continuously expands their knowledge to support program success.

The position is based at 50 West Town Street, Columbus, Ohio, and requires reporting to that location full-time. Travel is required as needed, and the employee must provide their own transportation or have a valid driver's license from their state of residence to operate a state vehicle. The position is permanent, full-time, classified, exempt from union membership, and exempt from overtime. The schedule is 8:00 a.m. to 5:00 p.m., with compensation of $40.40 per hour.

Requirements

• Completion of a graduate core program in business, management or public administration, public health, health administration, social or behavioral science, or public finance.
• Twelve months of experience in the delivery of a health services program or health services project management, such as health care data analysis, health services contract management, health care market and financial expertise, health services program communication, health services budget development, HMO and hospital rate development, health services eligibility, or health services database analysis.
• Twelve months of experience as a Medicaid Health Systems Specialist (65293) may substitute for the required experience, but not for any mandated licensure.
• Equivalent of the minimum class qualifications for employment 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 issues concerning Medicaid health services delivery, a current and valid registered nurse license issued by the Ohio Board of Nursing is required.
• Must report full-time to the work location at 50 West Town Street, Columbus, Ohio.
• Must provide own transportation, or have a valid driver's license from their 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 leave, sick leave, and 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, including OPERS, STRS, SERS, and HPRS, and optional deferred compensation through Ohio Deferred Compensation.

What This Job Offers

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