HYBRID - Managed Care Network and Provider Oversight Administrator (Medicaid Health Systems Administrator 2)

What You Will Do At ODM:

Office : Managed Care

Bureau : Managed Care Compliance & Oversight

Classification : Medicaid Health Systems Administrator 2 (PN 201012016 )

Job Overview :

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

• Supervising Managed Care Organizations (MCOs)/MyCare Ohio Plans (MCOPs) network and provider oversight team
• Assisting section chief to build strategies for the coordinated and expanded oversight of the managed care provider network including the creation of a new provider and access oversight team.
• Managing and oversight of provider management network (PNM), provider master file (PMF) for MCOs/ MCOPs
• Managing MCO/MCO network development and provider recruitment plans
• Manage external quality review organization (EQRO) managed care contract requirements for MCOs or MCOPs
• Monitoring Code of Federal Register (CFR)/ Ohio Administrative Code (OAC)/ Provider Agreement (PA)/ 3-way compliance for MCOs/ MCOPs provider network, access, and directory requirements
• Leading with the development of new methodology for determining network adequacy/ standards for the Managed Care Organizations (MCOs) and the MyCare Organization Plans (MCOPs)

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; 24 mos. exp. in planning & administering 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 analysis).

-Or 24 months experience as a Medicaid Health Systems Administrator 1, 65295. Note: education & experience is to be commensurate with approved position description on file.

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

Technical Skills: Health Administration

Professional Skills: Attention to Detail, Collaboration, Critical Thinking, Delegation, Decision Making, Goal Setting, Leading Others, Managing Meetings, Organizing and Planning, Verbal Communication, Written Communication