Healthcare Program Manager - Policy Management & Development (Medicaid

Schedule: Full-time

What You Will Do at ODM:

Office: Policy

Bureau: Health Plan Policy

Classification: Medicaid Health Systems Administrator 1 (PN 20102547)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare administrator to join the Policy Management and Development (PMD) Team to assist with developing, implementing, and managing general provisions of the Ohio Medicaid Program. This team is responsible for developing and implementing Ohio Administrative Code (OAC) rules that apply broadly concerning topics such as fraud/waste/abuse, payment, coordination of benefits, telehealth, claim submission, prior authorization, electronic data interchange and national standards, and HIPAA compliant healthcare transactions. As a PMD Healthcare Program Manager, your responsibilities will include:

Becoming a subject matter expert on assigned policies and managing updates to Ohio Administrative Code (OAC) rules, the Medicaid State Plan, Ohio Medicaid Enterprise System (OMES), and other systems or programs as needed.

Evaluating and assessing program needs and requirements for improving oversight and enforcement of general provisions.

Completing updates to OAC rules and the State Plan, managing the filing process, and implementing necessary changes across the agency to support operations.

Ensuring policies comply with federal and state regulations, rules, and laws.

Evaluating and analyzing policies related to the design and regulatory oversight of general Medicaid provisions as assigned.

Acting as a policy liaison and collaborating with other areas of ODM, sister state agencies, and/or external stakeholder groups.

Communicating with stakeholders and developing instructional or educational materials to support implementation of assigned policies.

Responding to inquiries from internal and external stakeholders regarding assigned policies.

The preferred candidate will have strong writing skills, experience researching state/federal laws or regulations, and experience developing policy or guidance documents.

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.

-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

Technical Skills: Public Health, Program Management, Technical Writing

Professional Skills: Collaboration, Analyzation, Written Communication