Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Admin at Ohio Department of Administrative Services

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Full Time

Start Date

Immediate

Expiry Date

29 Mar, 26

Salary

0.0

Posted On

30 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Health Administration, Critical Thinking, Problem Solving, Organizational Skills, Time Management, Data Analysis, Contract Management, Budget Development, Financial Performance Monitoring, Compliance, Healthcare Expense Monitoring, Stakeholder Engagement, Medicaid Program Knowledge, Capitation Rate Management, Legislative Inquiry Response

Industry

Government Administration

Description

What You Will Do at ODM: Office: Fiscal Operations Bureau: Rate Setting/Cost Setting Classification: Medicaid Health Systems Administrator 1 (PN 20093446) Job Overview: 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 unit is responsible for developing premium rates paid to insurance companies which manage the healthcare of Medicaid recipients. As the Medicaid Managed Care (MMC) Rate Setting Program Manager, your responsibilities will include: 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 The preferred candidates will be detail-oriented, have strong critical thinking and problem-solving skills, the ability to manage multiple priorities, and display great organizational and time management abilities. Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. 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 has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required. Note: education & experience is to be commensurate with approved position description on file. -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. Job Skills: Health Administration

Responsibilities

The role involves managing and administering the Ohio Medicaid Program's premium rates and serving as a liaison between various stakeholders. Responsibilities also include monitoring financial performance and ensuring compliance with reporting requirements.