Disability Determination Nurse (Medicaid Health Systems Specialist

Schedule: Full-time

What You Will Do at ODM:

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN 20047592)

Job Overview:

The Registered Nurse (RN) in this position will:

Utilize the Ohio Administrative Code (OAC), and Federal rules, policies, and procedures to make clinical/medical based definitive decisions to determine disability

Review and evaluate medical records and statistical reports

Frequently use electronic medical documentation and software applications, interact with providers, other agencies and external stakeholders

Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing.

-Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.

-Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.

-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