Medicaid Quality Control Analyst (Case Management Analyst)

What You Will Do At ODM Office: Legal Counsel Bureau: Program Integrity Classification: Case Management Analyst (PN: 20042098) Job Overview The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to be part of our Medicaid Eligibility Quality Control (MEQC) unit. This person will complete quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services, to ensure timeliness and accuracy statewide. As a Medicaid Quality Control Analyst, your responsibilities will include: Conducting comprehensive case reviews of County Departments of Job and Family Services (CDJFS) and other participating agencies’ records that determine eligibility for Medicaid programs.Reviewing approval/denials of random selected CHIP and Medicaid cases to evaluate the eligibility determination accuracy.Analyzing automated computer information systems to ensure county compliance with federal and state rules, regulations, and policies.Verifying all aspects of Medicaid eligibility by reviewing case record information, electronic verifications, and eligibility system actions.Making a final determination at the conclusion of the case review findings and providing results and analysis of reviews.Ensuring compliance with federally mandated MEQC rules and regulations.Communicating with ODM leadership about issues identified during reviews. The preferred candidate will have a background in Medicaid eligibility and possess strong analytical skills with attention to detail. Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license. Or 36 mos. exp. as public assistance caseworker, with experience in all categories of public assistance; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.Or equivalent of Minimum Class Qualifications for Employment noted above. Technical Skills: Health Administration Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication Agency Contact Name and Information HumanResources@medicaid.ohio.gov Unposting Date Oct 14, 2026, 10:59:00 PM Work Location Lazarus 4 Primary Location United States of America-OHIO-Franklin County-Columbus Compensation $$31.47/hour Schedule Full-time Work Hours 8:00 am - 5:00 pm Classified Indicator Classified Union OCSEA Agency Overview About Us: 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 and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help. Responsibilities Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by: Delivering a personalized care experience to more than three million people served. Improving care for children and adults with complex behavioral health needs. Working collectively with our partners and providers to measurably strengthen wellness and health outcomes. Streamlining administrative burdens so doctors and healthcare providers have more time for patient care. Ensuring financial transparency and operational accountability across all Medicaid programs and services.