Managed Care Rate Setting Manager - PN 20047481 (Medicaid Health Systems Administrator 1)
About the Organization
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine's agenda for Ohio's future. To ensure Ohio is "the best place to live, work, raise a family and start a business," we must have strong schools, a great quality of life, and compassion for those who need our help. The Ohio Department of Medicaid plays a unique and necessary role as the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, supporting the health and wellbeing of nearly one in every four Ohioans served. The department delivers a personalized care experience to more than three million people, improves care for children and adults with complex behavioral health needs, works collectively with partners and providers to measurably strengthen wellness and health outcomes, streamlines administrative burdens so doctors and healthcare providers have more time for patient care, and ensures financial transparency and operational accountability across all Medicaid programs and services.
About the Role
Office: Fiscal Operations. Classification: Medicaid Health Systems Administrator 1 (PN 20047481). The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare administrator to join the Managed Care Rate Setting (MCRS) team to assist with managing and administering general provisions of the Ohio Medicaid Program. This unit is responsible for developing premium rates paid to insurance companies which manage the healthcare of Medicaid recipients. As the Managed Care Rate Setting Manager, you will serve as a liaison between the State's seven Managed Care Organizations (MCOs), the State's actuary, and internal stakeholders in the development and administration of Medicaid Managed Care (MMC) capitation rates.
Responsibilities
- Interfacing with internal stakeholders, along with the State's actuary, to monitor MCO financial performance
- Ensuring compliance with CMS reporting requirements such as submission of MMC capitation rate certifications, amendments, MLR reporting, and preprints
- Managing and validating the loading of MMC capitation rates into the State's financial payment system
- Monitoring healthcare expense data
- Identifying and tracking Medicaid program changes impacting premium rate calculations and identifying changes in budget estimates
- Managing the reconciliation of various program initiatives and facilitating the entry, processing, payment, and/or recoupment of funds, by program and plan, respectively
- Monitoring and responding to inquiries from plans, providers, legislative requests, and constituency groups