Managed Care Rate Setting Manager - PN 20047481 (Medicaid Health Systems Administrator 1)

State of Ohio • Columbus, OH

6d • Onsite

About The Position

The Ohio Department of Medicaid is seeking an experienced healthcare administrator to join its Managed Care Rate Setting team in the Fiscal Operations office. The team develops premium rates paid to insurance companies that manage healthcare for Medicaid recipients. The position assists with managing and administering general provisions of the Ohio Medicaid Program and is based at 50 West Town Street, Columbus, Ohio. The employee is required to report to this location full-time. Travel may be 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.

Requirements

• Completion of a graduate core program in business, management or public administration, public health, health administration, social or behavioral science, or public finance.
• At least 12 months of experience delivering a health services program or managing a health services project, such as healthcare data analysis, health services contract management, healthcare 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.
• Alternatively, 12 months of experience as a Medicaid Health Systems Specialist may substitute for the required experience, but not for any required licensure.
• Equivalent qualifications may substitute for the experience requirement, but not for any required licensure.
• If the position oversees assessment or reassessment of clinical appropriateness of services, payment policies, or related Medicaid health-services delivery issues, a current and valid registered nurse license issued by the Ohio Board of Nursing is required.
• Must provide own transportation, or have a valid driver's license from their state of residence to operate a state vehicle.
• Must report full-time to the Columbus work location if selected.

Nice To Haves

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

Responsibilities

• Serve as a liaison among the State’s seven Managed Care Organizations, the State’s actuary, and internal stakeholders in developing and administering Medicaid Managed Care capitation rates.
• Work with internal stakeholders and the State’s actuary to monitor Managed Care Organization financial performance.
• Ensure compliance with CMS reporting requirements, including capitation rate certifications, amendments, Medical Loss Ratio reporting, and preprints.
• Manage and validate loading Medicaid Managed Care capitation rates into the State’s financial payment system.
• Monitor healthcare expense data.
• Identify and track Medicaid program changes that affect premium rate calculations and identify changes in budget estimates.
• Manage reconciliation of program initiatives and facilitate the entry, processing, payment, and/or recoupment of funds by program and plan.
• Monitor and respond to inquiries from plans, providers, legislative requesters, and constituency groups.

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.
• Optional deferred compensation through Ohio Deferred Compensation.

What This Job Offers

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