Long-Term Care Rate Setting Manager (Medicaid Health Systems Administrator 1)

State of Ohio • Columbus, OH

13d • Onsite

About The Position

The Ohio Department of Medicaid (ODM) is seeking an experienced professional to join the Nursing Facility (NF) Long-Term Care (LTC) Rate Setting Team. This team is responsible for developing, maintaining, and analyzing NF reimbursement rates, as well as supporting related operational, policy, and regulatory functions. This role will oversee rate development and the analytical, operational, and policy work that supports Ohio’s NF reimbursement program.

Requirements

• Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a 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 base analysis).
• OR 12 months experience as a Medicaid Health Systems Specialist, 65293.
• OR equivalent of Minimum Class Qualifications for Employment.
• Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Nice To Haves

• Health Administration
• Public Health
• Program Management
• Collaboration
• Innovation
• Critical Thinking
• Problem Solving

Responsibilities

• Developing semi-annual NF rates and managing rate adjustments throughout the year (e.g. CHOW/CHOP updates, new facilities, and rate reconsiderations).
• Performing data analysis related to NF claims, cost reports, franchise permit fee, and upper payment limit calculations.
• Maintaining and operating NF rate setting components within the Ohio Medicaid Enterprise System (OMES).
• Reviewing legislative proposals, inquiries, statutes, and rules related to NF rates, providing feedback, cost estimates, and budget projections.
• Collaborating with teams across Policy, Budget, Data Governance, Fiscal, Franchise Permit Fee, and LTC Enrollment to ensure consistent communication and alignment on rate related initiatives.
• Managing the NF Private Room Incentive Program (e.g. rule review, application approvals and denials, attestation processes, and monitoring claims to ensure spending remains within the cap).
• Monitoring NF enrollment, MDS trends, cost report patterns, Medicaid days, licensed beds, and other key data to support projections and policy development.
• Responding to inquiries from NF associations, managed care plans, and providers regarding NF rates.

Benefits

• 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 )

What This Job Offers

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