HYBRID - Managed Care Contract Manager (Medicaid Health Systems Administrator 1)

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.

About Us:

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program - focusing on the individual rather than the business of managed care.

The goals of the next generation of Ohio Medicaid are:

• Emphasize a personalized care experience
• Improve care for children and adults with complex behavioral health needs
• Improve wellness and health outcomes
• Support providers in better patient care
• Increase program transparency and accountability

What You Will Do At ODM:

Office: Managed Care

Bureau: Managed Care Compliance & Oversight

Classification: Medicaid Health Systems Administrator 1 (PN 20046577)

Job Overview:

As the Managed Care Contract Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Managing program information and conducting analyses to inform and direct policy changes and updates
• Conducting evaluations for managed care plans
• Performing research and answering questions related to legislative and policy initiatives such as implementation and ongoing assessment of new programs, populations and/or initiatives
• Leading on managed care related policy issues, implementations, and targeted reviews
• Working with the managed care plans to identify areas of concern
• Reviewing and approving policies
• Ensuring system updates are implemented timely and accurately, and providing technical assistance when required
• Communicating any compliance actions to the assigned Managed Care Plans

There are 5 MyCare Plans and 7 Managed Care Organizations (MCOs) that you will be working with.

MyCare Plans:

• Aetna Better Health of Ohio, Inc.
• Buckeye Health Plan
• CareSource
• Molina HealthCare of Ohio, Inc.
• UnitedHealthcare Community Plan

Managed Care Organizations (MCOs)

• AmeriHealth Caritas Ohio, Inc.
• Anthem Blue Cross and Blue Shield
• Buckeye Health Plan
• CareSource
• Humana Healthy Horizons in Ohio
• Molina HealthCare of Ohio, Inc.
• UnitedHealthcare Community Plan

What’s In It For You:

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

• Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.

Dental, Vision and Basic Life Insurance

• Dental, vision and basic life insurance premiums are free after one year of continuous service.

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave
• 11 paid holidays per year
• Childbirth/Adoption leave

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.

Deferred Compensation

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

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 data base analysis).

• Or 12 months experience as a Medicaid Health Systems Specialist, 65293.

• Or equivalent of Minimum Class Qualifications for Employment noted above.

Supplemental Information:

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

This position is overtime exempt.

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.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

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.

The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.