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

Ohio Department of Administrative Services • Columbus, OH

6h

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.

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)
• 12 months experience has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required.
• 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.
• Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Nice To Haves

• detail-oriented
• strong critical thinking and problem-solving skills
• the ability to manage multiple priorities
• display 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees