Provider Quality Assurance Manager

Schedule: Full-time

About the Role

AGE is looking for a highly motivated and talented individual to join the Division of Community Living (DCL) as the Provider Quality Assurance Manager. DCL manages home and community-based services (HCBS) for seniors and younger adults with disabilities. These services are accessed through the Aging and Disability Network and funded by Medicaid, state funds, and grants.

The PASSPORT Waiver program and the Assisted Living Waiver program are two examples of HCBS services. Highly-qualified providers are needed to care for and serve the program participants. The Provider Quality Assurance Manager will serve as a lead worker that ensures HCBS providers provide quality of care.

The job duties of this position include but are not limited to:

Formulate and implement policies, procedures, legislative rules, and practices to continue and/or enhance the quality of care delivered by HCBS providers;

Leads efforts with other state agencies on HCBS providers;

Research, review, and remedy claims issues in collaboration with AGE internal staff and ODM;

Conduct audits (desk and on-site) of providers;

Oversee administration of standard disciplinary action notices and, under minimal oversight, administer disciplinary action notices for the more complex cases.

For more in-depth job duties, please click here to view the position description.

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