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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