Managed Care Contract Manager (Medicaid Health Systems Administrator 1)

About the role

The Managed Care Contract Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), oversees contract management and compliance for managed care plans, informing policy changes and ensuring adherence to legislative and program requirements.

Responsibilities

• Manage program information and conduct analyses to inform and direct policy changes and updates.
• Conduct evaluations for managed care plans.
• Perform research and address questions related to legislative and policy initiatives, including implementation and assessment of new programs, populations, or initiatives.
• Lead on managed care-related contract issues, implementations, and targeted reviews.
• Collaborate with Managed Care plans to identify areas of concern and provide technical assistance as needed.
• Review and approve submitted reports and deliverables outlined in the Managed Care Provider Agreements.
• Communicate compliance actions to assigned Managed Care Plans.

You will work with 4 MyCare Plans and 7 Managed Care Organizations (MCOs):

• 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.

Requirements

• Completion of a graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance.
• 12 months of 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 database analysis).
• OR 12 months of experience as a Medicaid Health Systems Specialist, 65293.
• OR equivalent of the Minimum Class Qualifications for Employment noted above.

Skills

• Technical Skills: Health Administration
• Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication

Pay

$40.40 per hour

Schedule

• Work Hours: 8:00 am – 5:00 pm
• Type: Full-time

About the Agency

The Ohio Department of Medicaid plays a key role in supporting Governor DeWine’s vision for Ohio by delivering high-quality, person-centric healthcare to nearly one in every four Ohioans. Key initiatives include:

• Delivering a personalized care experience to over three million people.
• Improving care for children and adults with complex behavioral health needs.
• Collaborating with partners and providers to strengthen wellness and health outcomes.
• Streamlining administrative burdens for healthcare providers.
• Ensuring financial transparency and operational accountability across Medicaid programs.