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Ohio Department of Medicaid · 2 weeks ago

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

Columbus, OH

Full-time

Onsite

Entry, Mid Level

$39.22/hr - $39.22/hr

1+ years exp

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 role involves developing premium rates for insurance companies managing the healthcare of Medicaid recipients.

Government Administration

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 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

Qualification

Health AdministrationMedicaidAccountingFinanceHealth Services Program ManagementAnalyzationVerbal CommunicationWritten CommunicationCritical ThinkingProblem-SolvingOrganizational SkillsTime Management

Required

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 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

Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure