Direct Enrollment Supervisor (Medicaid Health Systems Administrator 1)

Schedule: Full-time

What You Will Do at ODM:

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Administrator 1 (PN 20045501)

Job Overview:

As the Direct Enrollment Supervisor, your responsibilities will include:

Managing Medicaid eligibility operations for key interagency initiatives, including:

Breast and Cervical Cancer Project (Ohio Department of Health)

Pre-Release and Inpatient Hospitalization programs (Department of Rehabilitation and Correction, and Department of Youth Services

Supervising staff responsible for making Medicaid eligibility determinations in the Ohio Benefits system

Overseeing the management of ODM’s caseload within the Ohio Benefits system

Ensuring accurate and timely eligibility determinations to support consumer access to care and reduce recidivism

Managing the Direct Reimbursement Program, including claim processing and reimbursement for out-of-pocket services

Reviewing and interpreting rule and policy changes from partner state agencies (Department of Rehabilitation and Correction, Department of Youth Services, and Department of Health)

Recommending and implementing updates to ODM's policies and procedures based on changes in Ohio Administrative Code (OAC)

Collaborating with internal and external stakeholders to ensure alignment and compliance across interagency initiatives

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