Network Oversight Manager (Medicaid Health Systems Administrator 1)

Highland County Joint Township • Ohio, IL

34d

About The Position

As the Network Oversight Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include: Provider Network Oversight lead for the Medicare-Medicaid plans (MMPs) ensuring compliance with the Code of Federal Register (CFR), Ohio Administrative Code(OAC), and Provider Agreement (PA) Monitoring network adequacy through reporting, provider updates, and compliance reviews Evaluating provider terminations and changes to assess impact to provider network Coordinating and facilitating monthly provider group meetings between the Ohio Department of Medicaid and Managed Care Entities Managing and updating key provider network deliverables and reporting templates Ensuring compliance with current Medicaid and Medicare policy, procedures, rules, and regulations as required Supporting the development of network adequacy methodologies and contributing to annual reporting and strategic planning Acting as liaison between the Office of Managed Care and internal and external stakeholders Identifying and escalating provider network issues to leadership and recommending solutions to maintain or improve member access to care

Requirements

• Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance
• 12 months experience 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 noted above.
• Technical Skills: Health Administration
• Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication

Responsibilities

• Provider Network Oversight lead for the Medicare-Medicaid plans (MMPs) ensuring compliance with the Code of Federal Register (CFR), Ohio Administrative Code(OAC), and Provider Agreement (PA)
• Monitoring network adequacy through reporting, provider updates, and compliance reviews
• Evaluating provider terminations and changes to assess impact to provider network
• Coordinating and facilitating monthly provider group meetings between the Ohio Department of Medicaid and Managed Care Entities
• Managing and updating key provider network deliverables and reporting templates
• Ensuring compliance with current Medicaid and Medicare policy, procedures, rules, and regulations as required
• Supporting the development of network adequacy methodologies and contributing to annual reporting and strategic planning
• Acting as liaison between the Office of Managed Care and internal and external stakeholders
• Identifying and escalating provider network issues to leadership and recommending solutions to maintain or improve member access to care

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Executive, Legislative, and Other General Government Support
• Number of Employees: 5,001-10,000 employees