Administrative Management, Analysis Skills, Budget Management, Continuous Improvement, Contract Management, Data Analysis, Database Analysis, Health Maintenance Organization (HMO), Health Plan, Healthcare, Healthcare Administration, Hospital, Managed Care, Medicaid, Office Management, Original Design Manufacturer (ODM), Policy Development, Presentation/Verbal Skills, Program Evaluation, Project/Program Management, Public Administration, Public Finance, Public Health, Service Delivery, Social Sciences, Systems Administration/Management, Team Player, Technical Support
What You Will Do At ODM:
Office: Managed Care
Bureau: Contract Management & Compliance
Classification: Medicaid Health Systems Administrator 1 (PN: 20089575)
Job Overview:
As the Managed Care Contract Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Managing program information and conducting analyses to inform and direct policy changes and updates
- Conducting evaluations for managed care plans
- Performing research and answering questions related to legislative and policy initiatives such as implementation and ongoing assessment of new programs, populations and/or initiatives
- Leading on managed care related contract issues, implementations, and targeted reviews
- Working with the Managed Care plans to identify areas of concern and provide technical assistance as needed.
- Reviewing and approving submitted reports and deliverables outlined in the Managed Care Provider Agreements
- Communicating any compliance actions to the assigned Managed Care Plans
There are 4 MyCare Plans and 7 Managed Care Organizations (MCOs) that you will be working with.
MyCare Plans:
- Anthem Blue Cross and Blue Shield
- Buckeye Health Plan
- CareSource
- Molina HealthCare of Ohio, Inc.
Managed Care Organizations (MCOs)
- AmeriHealth Caritas Ohio, Inc.
- Anthem Blue Cross and Blue Shield
- Buckeye Health Plan
- CareSource
- Humana Healthy Horizons in Ohio
- Molina HealthCare of Ohio, Inc.
- UnitedHealthcare Community Plan
Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 months experience 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 as a Medicaid Health Systems Specialist, 65293.
- Or equivalent of Minimum Class Qualifications for Employment noted above.
Technical Skills: Health Administration
Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication