Compliance Review Manager - PN 20090769 (Medicaid Health Systems Administrator 1)

• All job postings will expire at 11:59 PM Eastern Time on the application deadline.
• Organization: Medicaid
• Agency Contact Name and Information: [email protected]

Work Location

• Compensation: $40.40/hour
• Schedule: Permanent - Full Time
• Work Hours: 8:00 am - 5:00 pm
• Classified Indicator: Classified
• Union: Exempt from union
• Overtime Status: Exempt
• Primary Job Skill: Health Administration

Who We Are

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.

Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:

Delivering a personalized care experience to more than three million people served.

Improving care for children and adults with complex behavioral health needs.

Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.

Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.

Ensuring financial transparency and operational accountability across all Medicaid programs and services.

What You'll Do

• Office: Operations
• Classification: Medicaid Health Systems Administrator 1 (PN 20090769)
• Bureau: Network Management

Job Overview

The Ohio Department of Medicaid (ODM) is seeking a Health Systems Administrator to join the Home and Community Based Services (HCBS) Waiver Provider Oversight team to oversee provider compliance with Conditions of Participation for the Ohio Home Care and MyCare Ohio waiver programs. As the Compliance Review Manager, your key responsibilities will be:

Drafting proposed adjudication orders and application denial letters.

Conducting quality assurance reviews of waiver provider structural reviews for independent providers.

Analyzing waiver provider performance data to evaluate compliance and identify opportunities for continuous quality improvement.

Responding to inquiries from waiver providers, provider advocates, internal ODM staff and partner state agencies.

Collaborating with internal and external stakeholders to support waiver program operations, compliance activities, and policy implementation.

The ideal candidate is a detail-oriented, analytical professional who applies critical thinking and data-driven decision-making to complex challenges while delivering accurate, high-quality results. They excel at managing competing priorities, communicating effectively, collaborating with diverse stakeholders, and continuously expanding their knowledge to support program success.

The Ohio Department of Medicaid does not provide employment-based visa sponsorship.

Compensation is as listed on the posting unless required by legislation or union contract.

The work location of this position is 50 West Town Street, Columbus, Ohio 43215. You will be required to report to this work location full-time, if selected.

Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Why Work for the State of Ohio

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

Medical Coverage

• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
• *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

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

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.