Managed Care Policy Administrator (Medicaid Health Systems Administrator 2)
About The Position
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 analyzing policies related to member and provider contracted deliverables in Medicaid Managed Care Programs Implementing Medicaid State Plan Amendment (SPA) and Ohio Administrative Code (OAC) rule changes, changes to managed care programs Communicating responsibility and obligation of managed care entities (MCEs) to individuals and other government agencies Developing policy, provider agreements and guidance memorandum Providing additional direction in the processing of provider agreements, administrative rules, state directed payments, and federal authorities 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 Formulating policy and recommends legislative and programmatic changes
Requirements
- 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.
- Health Administration
- Attention to Detail
- Collaboration
- Critical Thinking
- Decision Making
- Goal Setting
- Managing Meetings
- Organizing and Planning
- Verbal Communication
- Written Communication
Responsibilities
- Planning, managing, evaluating, and analyzing policies related to member and provider contracted deliverables in Medicaid Managed Care Programs
- Implementing Medicaid State Plan Amendment (SPA) and Ohio Administrative Code (OAC) rule changes, changes to managed care programs
- Communicating responsibility and obligation of managed care entities (MCEs) to individuals and other government agencies
- Developing policy, provider agreements and guidance memorandum
- Providing additional direction in the processing of provider agreements, administrative rules, state directed payments, and federal authorities
- 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
- Formulating policy and recommends legislative and programmatic changes
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 )
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What This Job Offers
Job Type
Full-time
