Clinical Review Manager (Medicaid Health Systems Administrator 1)

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.

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.

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

Job Skills: Health Administration

Technical Skills\: Formulating and implementing policies and procedures, Collaborating

Professional Skills: Consultation, Collaboration, Attention to Detail, Priority Setting, Decision Making, Verbal Communication, Written Communication, Goal Setting, Problem Solving

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.

What You Will Do At ODM:

Office: Health Innovation & Quality

Bureau: Clinical Operations

Classification\: Medicaid Health Systems Administrator 1 (PN 20047504)

Job Overview:

As the Clinical Review Manager in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:

Planning, coordinating and monitoring oversight activities for Medicaid programs

Assisting in developing program monitoring initiatives designed to evaluate and assess program compliance for state and federal requirements with a focus on health and safety and care management activities

Assisting with oversight of both internal and external reviews measuring program performance for various Medicaid Programs (e.g., Home and Community Based Waivers, Specialized Recovery Services Program, and managed care)

Serving as the Bureau of Clinical Operations coordinator for the External Quality Review Organization (EQRO) activities

Reviewing, analyzing, and interpreting data (e.g., survey results) and reports and provide recommendations for follow-up activities related to program performance

Working collaboratively with internal and external stakeholders across a variety of departments, levels, and state agencies to conduct and develop oversight activities

Supplemental Information:

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

This position is overtime exempt. 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.

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.