Network Oversight Manager (Medicaid Health Systems Administrator 1)

Network Oversight Manager (Medicaid Health Systems Administrator 1)

Organization: Medicaid

Work Location: Lazarus 5, 50 West Town Street, Columbus, 43215

Primary Location: United States of America-OHIO-Franklin County-Columbus

Compensation: $39.22/hour

Schedule: Full-time

Work Hours: 8:00 am - 5:00 pm

Classified Indicator: Classified

Union: Exempt from Union

Primary Job Skill: Health Administration

Technical Skills: Health Administration

Professional Skills: Collaboration, Innovation, Verbal Communication, Written Communication, Confidentiality, Continuous Improvement

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 a 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.

Job Description

What You Will Do At ODM:

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

Why Work for the State of Ohio

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.

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 data base 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

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.

Candidates selected for an interview will be required to complete a written assessment as part of the interview process.

ADA Statement: 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.

Drug-Free Workplace: 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.