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State of Ohio · 1 week ago

Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administrator 1)

United States of America-OHIO-Franklin County

Full-time

Onsite

Entry, Mid Level

1+ years exp

The State of Ohio is seeking an experienced healthcare administrator to join the Managed Care Rate Setting team. This role involves managing and administering provisions of the Ohio Medicaid Program, developing premium rates for insurance companies, and ensuring compliance with reporting requirements.

GovernmentOffice Administration

Responsibilities

Serving as liaison between the State’s seven Managed Care Organizations (MCOs), the State’s actuary, and internal stakeholders in the development and administration of MMC capitation rates

Interfacing with internal stakeholders, along with the State’s actuary, to monitor MCO financial performance

Ensuring compliance with CMS reporting requirements such as submission of MMC capitation rate certifications, amendments, MLR reporting, and preprints

Managing and validating the loading of MMC capitation rates into the State’s financial payment system

Monitoring healthcare expense data

Identifying and tracking Medicaid program changes impacting premium rate calculations and identifying changes in budget estimates

Managing the reconciliation of various program initiatives and facilitating the entry, processing, payment, and/or recoupment of funds, by program and plan, respectively

Monitoring and responding to inquiries from plans, providers, legislative requests, and constituency groups

Qualification

Health AdministrationHealth Services Project ManagementHealthcare Data AnalysisHealth Services Contract ManagementCritical ThinkingProblem SolvingOrganizational SkillsTime Management

Required

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)

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