ftlx0 ftlUtil_resetPagerequisitionDescriptionInterface descRequisition rdPager142403 true 142403 false Submission for the position\ Clinical Review Nurse Supervisor Medicaid Health Systems Administrator 1 - Job Number\ 2600048Z false 142403 false true Clinical Review Nurse Supervisor Medicaid Health Systems Administrator 1 2600048Z Medicaid Medicaid HumanResourcesmedicaid.ohio.gov HumanResourcesmedicaid.ohio.gov Jun 24 2026 9\29\00 AM Jun 24 2026 9\29\00 AM Lazarus 5 MCDLZ550 West Town StreetColumbus 43215 Lazarus 5 50 West Town Street Columbus 43215 United States of America-OHIO-Franklin County-Columbus United States of America-OHIO-Franklin County-Columbus 39.22hour 39.22hour Full-time Full-time 8\00 am - 5\00 pm 8\00 am - 5\00 pm Classified Classified Exempt from Union Exempt from Union Nursing Nursing Nursing Nursing Collaboration Innovation Verbal Communication Written Communication Confidentiality Continuous Improvement 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 DeWines agenda for Ohios future. To ensure Ohio is the best place to live work raise and 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 governors 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.
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 DeWines agenda for Ohios future. To ensure Ohio is the best place to live work raise and 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 governors 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.
What You Will Do At ODM\Office\ Legal CounselBureau\ Program IntegrityClassification\ Medicaid Health Systems Administrator 1 RN PN\ 20092018Job Overview\The Ohio Department of Medicaid ODM is seeking a Registered NurseRN to be a part of our SurveillanceUtilization Review Section SURS. SURS is charged with helping the agency review utilization of Medicaid services detect fraud waste and abuse and recover inappropriate payments to providers. As a Clinical Review Nurse Supervisor your responsibilities will include\Helping to manage an over 7million year hospital utilization contractReviewing necessary medical record reviews and making a determination on hospital appeals.Supervising and training RNs Auditors and Analysts in identifying fraud waste and abuse in the Medicaid program.Participatingleading meetings with external stakeholders including law enforcementDeveloping and implementing changes to processes and procedures as needed in a team environmentEvaluating provider clinical compliance with state and federal Program Integrity rulesEvaluating provider medical documentation and billing practices for fraud waste and abuseRecovering overpayments for medically unnecessary services via administrative procedures andor referrals to health oversight agenciesResponding to provider clinical reconsideration appeal requestsConsulting on clinical matters with ODM policy units and other state agenciesCoordinating clinical Program Integrity efforts with ODM contractors and managed care plansPresenting findings from clinical reviews of provider non-complianceResponding to inquiries from the public consumers providers and other agencies
What You Will Do At ODM\Office\ Legal CounselBureau\ Program IntegrityClassification\ Medicaid Health Systems Administrator 1 RN PN\ 20092018Job Overview\The Ohio Department of Medicaid ODM is seeking a Registered NurseRN to be a part of our SurveillanceUtilization Review Section SURS. SURS is charged with helping the agency review utilization of Medicaid services detect fraud waste and abuse and recover inappropriate payments to providers. As a Clinical Review Nurse Supervisor your responsibilities will include\Helping to manage an over 7million year hospital utilization contractReviewing necessary medical record reviews and making a determination on hospital appeals.Supervising and training RNs Auditors and Analysts in identifying fraud waste and abuse in the Medicaid program.Participatingleading meetings with external stakeholders including law enforcementDeveloping and implementing changes to processes and procedures as needed in a team environmentEvaluating provider clinical compliance with state and federal Program Integrity rulesEvaluating provider medical documentation and billing practices for fraud waste and abuseRecovering overpayments for medically unnecessary services via administrative procedures andor referrals to health oversight agenciesResponding to provider clinical reconsideration appeal requestsConsulting on clinical matters with ODM policy units and other state agenciesCoordinating clinical Program Integrity efforts with ODM contractors and managed care plansPresenting findings from clinical reviews of provider non-complianceResponding to inquiries from the public consumers providers and other agencies
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 ourTotal Rewards website Our benefits package includes\Medical CoverageFree Dental Vision and Basic Life Insurance premiums after completion of eligibility periodPaid time off including vacation personal sick leave and 11 paid holidays per yearChildbirth Adoption and Foster Care leaveEducation and Development Opportunities Employee Development Funds Public Service Loan Forgiveness and morePublic Retirement Systems such as OPERS STRS SERS and HPRS&Optional Deferred Compensation Ohio Deferred CompensationBenefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
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 ourTotal Rewards website Our benefits package includes\Medical CoverageFree Dental Vision and Basic Life Insurance premiums after completion of eligibility periodPaid time off including vacation personal sick leave and 11 paid holidays per yearChildbirth Adoption and Foster Care leaveEducation and Development Opportunities Employee Development Funds Public Service Loan Forgiveness and morePublic Retirement Systems such as OPERS STRS SERS and HPRS&Optional Deferred Compensation Ohio Deferred CompensationBenefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
Completion of graduate core program in business management or public administration public health health administration social or behavioral science or public finance12 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 Current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03-4723.09 of Ohio Revised CodeOr 12 months experience as Medicaid Health Systems Specialist 65293 may be substituted for the experience required but not for the mandated licensure.Note\ education & experience is to be commensurate with approved position description on file.-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required but not for the mandated licensure.Technical Skills\ NursingProfessional Skills\Collaboration Confidentiality Continuous Improvement Innovation Verbal Communication Written Communication Completion of graduate core program in business management or public administration public health health administration social or behavioral science or public finance12 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 Current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03-4723.09 of Ohio Revised CodeOr 12 months experience as Medicaid Health Systems Specialist 65293 may be substituted for the experience required but not for the mandated licensure.Note\ education & experience is to be commensurate with approved position description on file.-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required but not for the mandated licensure.Technical Skills\ NursingProfessional Skills\Collaboration Confidentiality Continuous Improvement Innovation Verbal Communication Written Communication
Supplemental Information\The Ohio Department of Medicaid does not provide employment-based visa sponsorship.Compensation is as listed on the posting unless required by legislation or union contract.Must poses Current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03-4723.09 of Ohio Revised CodeThis positions is overtime exempt.Travel required as needed. Must provide own transportation. Or in order to operate a state vehicle you must have a valid drivers license from state of residence.Resumes andor attachments are not reviewed. Therefore please provide detail in the work experience section of your application.
Supplemental Information\The Ohio Department of Medicaid does not provide employment-based visa sponsorship.Compensation is as listed on the posting unless required by legislation or union contract.Must poses Current & valid license as registered nurse as issued by Ohio Board of Nursing pursuant to Sections 4723.03-4723.09 of Ohio Revised CodeThis positions is overtime exempt.Travel required as needed. Must provide own transportation. Or in order to operate a state vehicle you must have a valid drivers license from state of residence.Resumes andor attachments are not reviewed. Therefore please provide detail in the work experience section of your application.
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. 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.
The State of Ohio is a drug-free workplace which prohibits the use of marijuana recreational marijuananon-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. The State of Ohio is a drug-free workplace which prohibits the use of marijuana recreational marijuananon-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. false 142403 142403 true 142403 false Submission for the position\ Clinical Review Nurse Supervisor Medicaid Health Systems Administrator 1 - Job Number\ 2600048Z false 142403 false trueftlerrors descRequisition.size 1 descRequisition.nbElements 1 descRequisition.isEmpty false descRequisition.hasElements true pSessionTimeout 0 pSessionWarning 0 pBeaconBeat 0 focusOnField csrftoken An1TLjQUZqHXqtm6lZMz8HVw8vB1CYXyNdLNVgrk emptyListToken isListEmpty false listCount displayCalloutInLegend true addThisRequired false jobboardListPageTitle commonDescriptionForAddThis alreadyAppliedColumnDisplayed false displayDraft displaymessage false initialHistoryPage 1 restoreInitialHistoryOnRefresh false applicationCandidateNo calloutPageDisplayed true descriptionLogginMandatory false displayAsMainHeader false displayListingsPerPage false displayUrgentNeed isApplicantUser true jobsPerPageCaption Job {0} out of {1} listEmptyIsApplicantUser true listLabels listLocales requisitionno 142403 interfaceIdForTimeZone requisitionDescriptionInterface isJobCartActionDisplayed true openDescFrom default serializedCriteria sortby 11requisitionDescriptionInterface
Apply for this position online Apply by Email Apply to this position by email Add this position to the job cart Job Description Agency Contact Name and Information Compensation Work Hours Classified Indicator Union Technical Skills Professional Skills Primary Technology Agency Overview Why Work for the State of Ohio Supplemental Information ADA Statement Drug-Free Workplace Tell us about a friend who might be interested in this job. All privacy rights will be protected. false Tell us about a person who might be interested in working for our organization. All privacy