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Medicaid Program Manager Jobs in Ohio (NOW HIRING)

CareSource

Program Manager, Vendor Performance

Dayton, OH · On-site +1

$94K - $164K/yr

The Program Manager, Market Vendor Performance is responsible for coordinating programs that ... Knowledge of MassHealth, or other Medicaid program regulations. Licensure and Certification: * None ...

Navtech, Inc.

Program Manager

Columbus, OH · On-site

$70/hr

I have an opportunity for " Program Manager " and looking for a candidate who can join Immediately ... Medicaid and/or healthcare systems development projects. * Demonstrate effective leadership ...

Integratedservice

IHBT Program Manager

Logan, OH · On-site

$73 - $93/hr

Monitor compliance with Medicaid, OhioMHAS, OhioRISE, CME, and payer requirements * Oversee ... managers with program operations across multiple counties and service areas * Assist with ...

Integratedservice

IHBT Program Manager

Coshocton, OH · On-site

$73 - $93/hr

Monitor compliance with Medicaid, OhioMHAS, OhioRISE, CME, and payer requirements * Oversee ... managers with program operations across multiple counties and service areas * Assist with ...

Integratedservice

IHBT Program Manager

Columbus, OH · On-site

$73 - $93/hr

Monitor compliance with Medicaid, OhioMHAS, OhioRISE, CME, and payer requirements * Oversee ... managers with program operations across multiple counties and service areas * Assist with ...

EssilorLuxottica

Medicaid Account Manager

Mason, OH · On-site

GENERAL FUNCTION The Market Manager - Reseller, Medicaid is responsible for developing strategic relationships and managing ongoing support of multiple state Medicaid programs administered by our ...

Essilor

Medicaid Account Manager

Mason, OH · On-site

GENERAL FUNCTION The Market Manager - Reseller, Medicaid is responsible for developing strategic relationships and managing ongoing support of multiple state Medicaid programs administered by our ...

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Medicaid Program Manager information

What does a Medicaid Program Manager do?

A Medicaid Program Manager oversees the administration and implementation of Medicaid programs at the state or organizational level. Their responsibilities include ensuring compliance with federal and state regulations, managing budgets, coordinating with stakeholders, and improving service delivery for Medicaid recipients. They often analyze data, develop policies, and work to enhance program efficiency and effectiveness. This role requires strong leadership, organizational, and policy analysis skills to ensure that eligible populations receive proper healthcare services.

What are the main challenges Medicaid Program Managers face in coordinating between state agencies and healthcare providers?

Medicaid Program Managers often navigate the complexities of aligning policies and procedures between state agencies and a diverse range of healthcare providers. Challenges can include managing frequent regulatory changes, ensuring compliance with both federal and state guidelines, and facilitating clear communication among stakeholders. Additionally, they must address provider concerns, resolve billing or service disputes, and adapt program initiatives to meet evolving healthcare needs. Strong organizational and relationship-building skills are essential to succeed in this collaborative and dynamic environment.

What are the key skills and qualifications needed to thrive as a Medicaid Program Manager, and why are they important?

To thrive as a Medicaid Program Manager, you need expertise in healthcare administration, knowledge of Medicaid regulations, and a relevant degree such as public health or healthcare management. Familiarity with Medicaid Management Information Systems (MMIS), data analytics tools, and compliance software is typically expected. Strong leadership, problem-solving, and communication skills enable effective team management and stakeholder engagement. These skills ensure efficient program operation, regulatory compliance, and the delivery of quality services to beneficiaries.

What are popular job titles related to Medicaid Program Manager jobs in Ohio?

For Medicaid Program Manager jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Medicaid Program Manager jobs in Ohio look for?

The top searched job categories for Medicaid Program Manager jobs in Ohio are:

What cities in Ohio are hiring for Medicaid Program Manager jobs?

Cities in Ohio with the most Medicaid Program Manager job openings:

Medicaid Program Manager jobs near you

Program Manager, Vendor Performance

CareSource

Dayton, OH • On-site, Remote

$94K - $164K/yr

Full-time

Posted 5 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

211th of 315 rated insurance

Job description

Job Summary:
The Program Manager, Market Vendor Performance is responsible for coordinating programs that support the delivery of member benefits including durable medical equipment (DME), home modification, and wheelchair repair services. This role partners with internal stakeholders and external service providers to improve member experience, monitor operational performance, drive continuous improvement and ensure compliance with contractual and regulatory requirements. The Program Manager influences outcomes through collaboration, data-driven decision making, and operational leadership. This role focuses on improving the product and member experience, ensuring regulatory compliance, and supporting operational excellence to enable safe community living for members.
Essential Functions:
  • Manage and support initiatives to improve member interactions with plan services and benefits.
  • Develop, monitor, and report on key performance indicators (KPI's), Service level agreements (SLA's) and operational dashboards with attention on timely delivery of services, quality metrics, member outcomes and ensuring high-quality service delivery.
  • Lead operational reviews to identify trends, risks, and opportunities for improvement.
  • Coordinate implementation of new initiatives and operational processes
  • Support the alignment of products and services with member needs, with attention to compliance, equity, accessibility, and quality.
  • Monitor and evaluate the end-to-end product service experience, identifying opportunities for improvement, streamlining operational workflows, improving member experience, reduce administrative burden, and escalation as appropriate.
  • Support the development of policies and procedures and document workflows, standard operating procedures and business requirements.
  • Serve as the operational liaison for contracted service providers, monitoring performance, resolving issues, facilitating communication, and ensuring alignment with organizational goals and contractual expectations.
  • Facilitate issue resolution with attention to addressing root causes among internal teams and external partners
  • Partner with internal stakeholders, including operations, grievances and appeals, compliance, and clinical teams, to support initiative execution and alignment with organizational goals.
  • Assist with communication and coordination with external stakeholders, including vendors and regulatory partners.
  • Support the development and administration of training and communication relevant to DME, wheelchair repairs, home modification and all else within scope of work to applicable stakeholders.
  • Provide analysis and insight on data pertinent to the role, including, but not limited to, DME trends in terms of cost, supplier volume and supplier performance.
  • Collaborate in the creation of materials needed to review SLAs, KPIs, status and more, as relevant to the role responsibilities.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in healthcare management, business, or related field required
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Seven (7) years of experience in healthcare operations, member services, or product experience roles required
  • Experience supporting vendor management and service delivery improvement initiatives required
  • Working knowledge of DME services, healthcare regulations, and compliance requirements required
  • Experience using operational metrics, dashboards, and data analysis to drive performance improvements preferred
Competencies, Knowledge and Skills:
  • Strong communications, analytical, and organizational skills
  • Program Management: Ability to coordinate multiple initiatives simultanteously while balancing competing priorities.
  • Analytical Thinking: Uses data, metrics, and performance trends to identify opportunities and recommend solutions.
  • Operational Effectiveness: Ability to support process improvements and tack measurable results.
  • Relationship Building: Builds effective working relationships internally and externally while building consensus to achieve shared goals.
  • Member-Centric Focus: Demonstrates commitment to improving member experience and outcomes.
  • Knowledge of Medicare Advantage rules and regulations.
  • Knowledge of MassHealth, or other Medicaid program regulations.
Licensure and Certification:
  • None
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Brand=Commonwealth Care Alliance

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