Ohio
Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administra
Ohio, Columbus, Ohio, United States, 43224
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 database analysis).
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.
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
#J-18808-Ljbffr
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 database analysis).
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.
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
#J-18808-Ljbffr