Managed Care Systems and Payments Administrator (Medicaid Health Systems Administrator 2)

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.

• What You Will Do At ODM:
• Office: Managed Care
• Bureau: Member Services
• Classification: Medicaid Health Systems Administrator 2 (PN: 20102513)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a professional to join the Bureau of Member Services. As Managed Care Systems and Payments Administrator, your responsibilities will include:

• Supervising staff, delegating responsibilities, and monitoring performance through SMART goals and coaching
• Leads policy development and system oversight for Medicaid Managed Care, and MyCare Ohio Programs.
• Develops and implements OAC rules and provider agreement requirements related to enrollment and capitation payments.
• Oversees system testing, defect resolution, and capitation payment adjustments in coordination with internal teams and CMS.
• Serves as the primary liaison for managed care plan inquiries and communicates updates to ODM leadership.
• Manages design and review of enrollment, eligibility, and capitation reports, including 834/820 files and dashboards.
• Coordinates audit responses for capitation and enrollment inquiries from state and federal oversight bodies.
• Leads managed care components of Ohio Benefits and Fiscal Intermediary testing, training, and transition activities.
• Represents the section in internal and external stakeholder meetings in the absence of the Bureau Chief.

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

• 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)

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

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

Professional Skills: Attention to Detail, Collaboration, Critical Thinking, Decision Making, Goal Setting, Managing Meetings, Organizing and Planning, Verbal Communication, Written Communication

Supplemental Information:

Compensation is as listed on the posting unless required by legislation or union contract.

This position is overtime exempt.

Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.