Network Oversight Manager (Medicaid Health Systems Administrator 1)

Network Oversight Manager (Medicaid Health Systems Administrator 1)

Ohio Department of Medicaid

Office: Managed Care

Bureau: Network Management & Operations

Classification: Medicaid Health Systems Administrator 1 (PN: 20045493)

Job Overview

As the Network Oversight Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

Provider Network Oversight lead for the Medicare-Medicaid plans (MMPs) ensuring compliance with the Code of Federal Register (CFR), Ohio Administrative Code (OAC), and Provider Agreement (PA)

Monitoring network adequacy through reporting, provider updates, and compliance reviews

Evaluating provider terminations and changes to assess impact to provider network

Coordinating and facilitating monthly provider group meetings between the Ohio Department of Medicaid and Managed Care Entities

Managing and updating key provider network deliverables and reporting templates

Ensuring compliance with current Medicaid and Medicare policy, procedures, rules, and regulations as required

Supporting the development of network adequacy methodologies and contributing to annual reporting and strategic planning

Acting as liaison between the Office of Managed Care and internal and external stakeholders

Identifying and escalating provider network issues to leadership and recommending solutions to maintain or improve member access to care

Qualifications

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 months experience 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 database analysis).

Or 12 months experience as a Medicaid Health Systems Specialist, 65293.

Or equivalent of Minimum Class Qualifications for Employment noted above.

Technical Skills

Health Administration

Professional Skills

Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication

Location

Lazarus 5, United States of America-OHIO-Franklin County-Columbus

Compensation

$39.22/hour

Schedule

Full-time

Job Hours

8:00 am - 5:00 pm

Unposting Date

Dec 2, 2025, 11:59:00 PM

Agency Overview

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 DeWines agenda for Ohios future. To ensure Ohio is the best place to live, work, raise families, and start a business, we must have strong schools, a great quality of life, and compassion for those who need our help.

Responsibilities

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.

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