HYBRID - External Quality Review Administrator (Medicaid Health Systems Administrator 2)

$85,758 - $85,758/Yr

Medicaid Agency - Columbus, OH

Part-time - Mid Level

Hybrid - Columbus, OH

Insurance Carriers and Related Activities

About the position

The External Quality Review Administrator at the Ohio Department of Medicaid is responsible for overseeing the implementation of external quality review program requirements for Ohio's Medicaid Managed Care Programs. This role focuses on improving the quality, timeliness, and access to care within the managed care delivery systems, ensuring compliance with federal regulations, and enhancing the performance of Managed Care Entities. The position involves developing policies, leading teams, analyzing regulations, and representing the agency in various workgroups.

Responsibilities

• Oversee implementation of external quality review program requirements for Medicaid Managed Care Programs.
• Develop external quality review program policies and procedures compliant with federal regulations.
• Lead intra-agency teams in the development and implementation of external quality review activities.
• Analyze and interpret federal and state regulations to ensure program compliance.
• Monitor external quality review vendor to ensure compliance with federal EQR regulations.
• Serve as the agency manager for Ohio Medicaid accreditation requirements.
• Lead meetings and presentations with internal and external stakeholders.
• Represent the agency in workgroups.

Requirements

• Completion of graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance.
• 24 months experience in planning and administering health services programs or health services project management.

Nice-to-haves

• Experience with health care data analysis.
• Health services contract management experience.
• Knowledge of health care market and financial expertise.

Benefits

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after eligibility period
• Paid time off including vacation, personal, sick leave, and 11 paid holidays
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities
• Public Retirement Systems and Optional Deferred Compensation