Job Description
What You Will Do At ODM:
Office : Health Innovation & Quality
Bureau: Health Research & Quality
Classification : Medicaid Health Systems Administrator 2 (PN 20101210)
Job Overview: The Ohio Department of Medicaid (ODM) is seeking an experienced professional to oversee implementation of external quality review program requirements for Ohio’s Medicaid Managed Care Programs (e.g., Managed Care, MyCare Ohio, OhioRISE, and the Single Pharmacy Benefit Manager). The External Quality Review (EQR) process is designed to improve ODM’s ability to monitor the Managed Care Entities and help them improve their performance with respect to quality, timeliness and access to care; achieving higher performing managed care delivery systems for Ohioans. As the External Quality Review Administrator, your responsibilities will include:
- Developing external quality review program policies and procedures that both comply with federal regulations and support ODM’s Managed Care Quality Strategy
- Leading intra-agency teams in the development and implementation of external quality review activities
- Analyzing and interpreting federal and state regulations, rules and laws to ensure program compliance
- Monitoring ODM’s selected external quality review vendor to assure work products comply with federal EQR regulations and meet ODM’s operational needs
- Serving as the agency manager for Ohio Medicaid accreditation requirements
- Leading meetings and presentations with both internal and external stakeholders
- Representing the agency in workgroups
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.
Technical Skills: Health Administration, Policy
Professional Skills: Attention to Detail, Collaboration,
Critical Thinking, Decision Making, Goal Setting, Managing Meetings, Organizing and Planning, Verbal Communication, Written Communication
Organization Medicaid
Agency Contact Name and Information HumanResources@medicaid.ohio.gov
Unposting Date Jan 22, 2025, 11:59:00 PM
Work Location Lazarus 5
Primary Location United States of America-OHIO-Franklin County-Columbus
Compensation $41.23/hour
Schedule Full-time
Work Hours 8:00 am - 5:00 pm
Classified Indicator Classified
Union Exempt from Union
Primary Job Skill Health Administration
Technical Skills Health Administration, Policy Direction
Professional Skills Attention to Detail, Collaboration, Critical Thinking, Decision Making, Goal Setting, Managing Meetings, Organizing and Planning, Verbal Communication, Written Communication
Agency Overview THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS About Us: Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department Of Medicaid Plays a Unique And Necessary Role In Supporting The Governor’s Vision. As The Single State Medicaid Agency Responsible For Administering High-quality, Person-centric Healthcare, The Department Is Committed To Supporting The Health And Wellbeing Of Nearly One In Every Four Ohioans Served. We Do So By:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Job Tags
Full time, Contract work, Remote job,