Compliance & Safety Check Nurse/Reviewer (Medicaid Health Systems Specialis at Ohio Department of Administrative Services

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Full Time

Start Date

Immediate

Expiry Date

14 Jan, 26

Salary

34.96

Posted On

17 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Nursing, Critical Thinking, Collaboration, Attention to Detail, Organizing and Planning, Verbal Communication, Written Communication, Confidentiality, Analyzation

Industry

Government Administration

Description

What You Will Do At ODM: Office: Health Innovation & Quality Bureau: Clinical Operations Classification: Medicaid Health Systems Specialist RN (PN 20102574, 20102575) Pay rate: $34.96/hour Job Overview: ***This position requires travel throughout Ohio, some of which will include overnight stay.*** This position is headquartered in Franklin County. As a Compliance & Safety Check Nurse/Reviewer in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include: Conducting compliance and safety check surveys, many of which occur in the consumer's home Conducting oversight activity to include medical & programmatic document review & face to face (e.g., may be conducted on-site) assessments &/or reassessment (e.g., questionnaires & documents to review programs) & all oversight activity of all Medicaid programs (e.g., PACE, PASSARR, Waiver) administered by other state agencies (e.g., Ohio Department of Education [ODE], Ohio Department of Health [ODH], Mental Health and Addiction Services [OMHAS], Ohio Department of Youth Services [ODYS], Ohio Department of Aging [ODA], Ohio Department of Developmental Disabilities [DODD]) & ODM Ohio Home Care/State Plan, Managed Care Reviewing & evaluating medical & programmatic documents developed by contractors, county boards & providers to determine quality assurance of health & safety & clinical &/or programmatic appropriateness of services &/or payment policies. As the Compliance and Safety Check Nurse/Reviewer, you will be required to possess a current and valid license to practice professional Nursing as a Registered Nurse (RN) in Ohio as issued by the Board of Nursing in order to conduct compliance and safety check surveys of Ohio's Medicaid consumers. Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing. -Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure. -Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure. Technical Skills: Nursing Professional Skills: Critical Thinking, Collaboration, Attention to Detail, Organizing and Planning, Verbal Communication, Written Communication, Confidentiality, Analyzation

Responsibilities

Conduct compliance and safety check surveys, including oversight activities and document reviews for Medicaid programs. Assess clinical appropriateness of services and payment policies.