Managed Care Rate Setting Manager (Medicaid Health Systems Administrator 1)

State of Ohio • Columbus, OH

9h • Onsite

About The Position

The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare administrator to join the Managed Care Rate Setting (MCRS) team to assist with managing and administering general provisions of the Ohio Medicaid Program. This unit is responsible for developing premium rates paid to insurance companies which manage the healthcare of Medicaid recipients. As the Managed Care Rate Setting Manager, your responsibilities will include: Serving as liaison between the State’s seven Managed Care Organizations (MCOs), the State’s actuary, and internal stakeholders in the development and administration of Medicaid Managed Care (MMC) capitation rates Interfacing with internal stakeholders, along with the State’s actuary, to monitor MCO financial performance Ensuring compliance with CMS reporting requirements such as submission of MMC capitation rate certifications, amendments, MLR reporting, and preprints Managing and validating the loading of MMC capitation rates into the State’s financial payment system Monitoring healthcare expense data Identifying and tracking Medicaid program changes impacting premium rate calculations and identifying changes in budget estimates Managing the reconciliation of various program initiatives and facilitating the entry, processing, payment, and/or recoupment of funds, by program and plan, respectively Monitoring and responding to inquiries from plans, providers, legislative requests, and constituency groups

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 has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required.
• Note: education & experience is to be commensurate with approved position description on file.
• If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery, incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code.
• Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
• 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

• Detail-oriented
• Strong critical thinking and problem-solving skills
• Ability to manage multiple priorities
• Great organizational and time management abilities

Responsibilities

• Serving as liaison between the State’s seven Managed Care Organizations (MCOs), the State’s actuary, and internal stakeholders in the development and administration of Medicaid Managed Care (MMC) capitation rates
• Interfacing with internal stakeholders, along with the State’s actuary, to monitor MCO financial performance
• Ensuring compliance with CMS reporting requirements such as submission of MMC capitation rate certifications, amendments, MLR reporting, and preprints
• Managing and validating the loading of MMC capitation rates into the State’s financial payment system
• Monitoring healthcare expense data
• Identifying and tracking Medicaid program changes impacting premium rate calculations and identifying changes in budget estimates
• Managing the reconciliation of various program initiatives and facilitating the entry, processing, payment, and/or recoupment of funds, by program and plan, respectively
• Monitoring and responding to inquiries from plans, providers, legislative requests, and constituency groups

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: Mid Level
• Number of Employees: 101-250 employees