Provider Network and Data Oversight Specialist (Health Services Policy

What You Will Do At ODM:

Office\: Managed Care

Bureau: Managed Care Compliance & Oversight

Classification: Health Services Policy Specialist (PN: 20102013)

Job Overview:

As Provider Network and Data Oversight Specialist, your will be responsible to:

Lead for managed care provider data management and provider network standard methodologies

Manage provider network reporting for managed care organizations (MCOs)/ MyCare Ohio plans (MCOP)

Assist with oversight of provider network management (PNM) module for Managed Care

Assist in communication of data

MCO/ MCOP provider enrollment liaison

MCO/ MCOP lead for the managed care network provider reconciliation files

Monitor Provider Agreement (PA)/ Code of Federal Regulations (CFR) Compliance

Monitor and review MCO/ MCOP directories for compliance with PA (data specifically)

About Us:

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.

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.

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.

Completion of graduate core coursework in health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.

-Or completion of undergraduate core coursework & 12 mos. exp. in one of following\: health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics, public health, or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis, graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.

-Or 2 yrs. exp. as Health Services Analyst, 65211.

-Or equivalent of Minimum Class Qualifications For Employment noted above.

Job Skills: Data Analytics

Technical Skills: Health Administration, Data Modeling, Data Visualization

Professional Skills: Analyzation, Attention to Detail, Collaboration, Innovation

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.

Supplemental Information:

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

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.