HYBRID - Managed Care Policy and Contracts Lead (Medicaid Health Systems Administrator 1)

$78,062 - $78,062/Yr

Medicaid Agency - Columbus, OH

Full-time - Mid Level

Hybrid - Columbus, OH

Insurance Carriers and Related Activities

About the position

The Managed Care Policy and Contracts Lead at the Ohio Department of Medicaid is responsible for overseeing the planning, management, and analysis of policies related to Medicaid managed care programs. This role involves implementing changes to state plans and eligibility rules, explaining enrollment processes to individuals, and ensuring compliance with federal and state regulations. The position requires collaboration with various stakeholders to enhance health outcomes and streamline administrative processes.

Responsibilities

• Plan, manage, research, evaluate, and analyze policies related to Medicaid managed care enrollment.
• Implement Medicaid State Plan Amendment (SPA) and eligibility changes to managed care enrolled populations.
• Explain eligibility and enrollment processes in managed care plans to individuals.
• Analyze data collected from managed care plans or providers.
• Develop policy, provider agreements, and guidance memoranda.
• Coordinate the processing of provider agreements, administrative rules, and federal authorities.
• Assist in providing strategic oversight of policies and procedures governing Medicaid managed care.
• Ensure compliance of managed care program policies with federal and state regulations.
• Assist higher-level administrators in the development and coordination of Medicaid health delivery systems programs.
• Formulate policy and recommend legislative and programmatic changes.

Requirements

• Completion of graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance.
• 12 months experience in health services program delivery or health services project management.
• Experience in health care data analysis, health services contract management, or health services budget development.

Nice-to-haves

• Experience as a Medicaid Health Systems Specialist.
• Knowledge of health services eligibility and database analysis.

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 per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities
• Public Retirement Systems and Optional Deferred Compensation