Long-Term Care Rate Setting Manager (Medicaid Health Systems Administrator 1)

What You Will Do at ODM:

Office: Policy

Bureau: Long Term Services & Supports

Classification: Medicaid Health Systems Administrator 1 (PN 20047434)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking an experienced professional to join the Nursing Facility (NF) Long-Term Care (LTC) Rate Setting Team. This team is responsible for developing, maintaining, and analyzing NF reimbursement rates, as well as supporting related operational, policy, and regulatory functions. This role will oversee rate development and the analytical, operational, and policy work that supports Ohio's NF reimbursement program. As the NF LTC Rate Setting Manager, your responsibilities will include:

• Developing semi-annual NF rates and managing rate adjustments throughout the year (e.g. CHOW/CHOP updates, new facilities, and rate reconsiderations).
• Performing data analysis related to NF claims, cost reports, franchise permit fee, and upper payment limit calculations.
• Maintaining and operating NF rate setting components within the Ohio Medicaid Enterprise System (OMES).
• Reviewing legislative proposals, inquiries, statutes, and rules related to NF rates, providing feedback, cost estimates, and budget projections.
• Collaborating with teams across Policy, Budget, Data Governance, Fiscal, Franchise Permit Fee, and LTC Enrollment to ensure consistent communication and alignment on rate related initiatives.
• Managing the NF Private Room Incentive Program (e.g. rule review, application approvals and denials, attestation processes, and monitoring claims to ensure spending remains within the cap).
• Monitoring NF enrollment, MDS trends, cost report patterns, Medicaid days, licensed beds, and other key data to support projections and policy development.
• Responding to inquiries from NF associations, managed care plans, and providers regarding NF rates.

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).

• Or 12 months experience has Medicaid Health Systems Specialist, 65293. Note: education & experience is to be commensurate with approved position description on file.
• Or equivalent of Minimum Class Qualifications for Employment.

Job Skills: Health Administration

Technical Skills: Public Health, Program Management

Professional Skills: Collaboration, Innovation, Critical Thinking, Problem Solving