Ohio Department of Medicaid
Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administra
Ohio Department of Medicaid, Columbus, Ohio, United States, 43224
Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administrator 1)
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
Qualifications 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 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 database 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. 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
Organization
Medicaid
Technical Skills
Accounting and Finance, Health Administration
Professional Skills
Analyzation, Verbal Communication, Written Communication
Agency Contact HumanResources@medicaid.ohio.gov
Work Location Lazarus 5
Primary Location United States of America-OHIO-Franklin County-Columbus
Compensation $39.22/hour
Schedule Full-time
Work Hours 8:00 am - 5:00 pm
Union Status Exempt from Union
Agency Overview 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.
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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
Qualifications 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 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 database 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. 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
Organization
Medicaid
Technical Skills
Accounting and Finance, Health Administration
Professional Skills
Analyzation, Verbal Communication, Written Communication
Agency Contact HumanResources@medicaid.ohio.gov
Work Location Lazarus 5
Primary Location United States of America-OHIO-Franklin County-Columbus
Compensation $39.22/hour
Schedule Full-time
Work Hours 8:00 am - 5:00 pm
Union Status Exempt from Union
Agency Overview 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.
#J-18808-Ljbffr