Quality Review Manager (Medicaid Health Systems Administrator 1)

Schedule: Full-time

What You Will Do at ODM:

Office: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Administrator 1 (PN 20090769)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a health systems administrator, who focuses on data analysis and problem solving, to oversee the Quality Assurance reviews for the Ohio Home Care Waiver program in the Bureau of Network Management. As the Quality Review Manager, you will be responsible for the following:

Conducting quality reviews of ODM Administered Home and Community Based Waiver Services (e.g., Ohio Home Care) provider structural reviews

Drafting Proposed Adjudication Orders and application denial letters

Participating in quality reviews of incident investigation

Performing data analysis of ODM Administered Home and Community Based Waiver Services (e.g., Ohio Home Care) provider performance measures

Responding to inquiries from waiver providers, provider advocates, internal ODM areas and sister state agencies

The preferred candidate will demonstrate meticulous attention to detail in their work, be solution orientated, and value collaboration. The preferred candidate will also desire to gain knowledge through research and possess the ability to adapt to change when necessary to meet the needs of the business.

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