THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS
About Us:
The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.
The goals of the next generation of Ohio Medicaid are:
- Emphasize a personalized care experience
- Improve care for children and adults with complex behavioral health needs
- Improve wellness and health outcomes
- Support providers in better patient care
- Increase program transparency and accountability
What You Will Do At ODM:
Office: Legal Counsel
Bureau: Program Integrity
Classification: Medicaid Health Systems Administrator 1 (PN 20091843)
Job Overview :
The Ohio Department of Medicaid (ODM) is seeking a Medicaid Eligibility Quality Control (MEQC) Supervisor to manage the MEQC Unit in the Bureau of Program Integrity. This person will work independently and with Program Integrity staff to oversee and direct quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services. As the MEQC Supervisor your responsibilities will include:
- Ensuring compliance with federally mandated MEQC reviews and any required corrective action plans
- Communicating with ODM leadership and County Departments of Job and Family Services (CDJFS) about issues identified during reviews
- Establishing the selection criteria for reviews of CDJFS eligibility determinations
- Assigning MEQC and Payment Error Rate measurement (PERM) reviews and ensuring required reviews are completed accurately and timely
- Supervising the MEQC team
- Collaborating with the audit coordination team on the eligibility sample of the PERM audit
The preferred candidate would have experience working well with others and independently, have strong analytical abilities, show initiative, and possess strong written and verbal communication skills.
What’s In It For You:
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 our Total Rewards website ! Our benefits package includes:
Medical Coverage
- Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
Dental, Vision and Basic Life Insurance
- Dental, vision and basic life insurance premiums are free after one year of continuous service.
Time Away From Work and Work/Life Balance
- Paid time off, including vacation, personal, and sick leave
- 11 paid holidays per year
- Childbirth/Adoption leave
Ohio Public Employees Retirement System
- OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
Deferred Compensation
- The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
Qualifications
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 as a 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 noted above.