Ohio Department of Commerce
Medicaid Health Systems Administrator 1
Ohio Department of Commerce, Columbus, Ohio, United States, 43224
What will you do?
Under administrative direction from the policy manager of Medicaid Development & Administration (MDA) acts as a project/team leader to review, monitor, and manage the day to day operations of the Financial Management Service (FMS) contract that supports the Developmental Disabilities (DD) self-direction service delivery system: reviews participant-directed goods and services (PDGS) purchases; reviews other reports tracking growth and utilization of self-directed services, acts as a liaison between the county boards of developmental disabilities (CB/DD) and FMS, stakeholders and FMS to assures issues are addressed timely; coordinates monthly meetings to address concerns from county boards, stakeholders, and the FMS; reviews Monthly Pass Allocation (MPA) as needed for Self-Directed Transportation; works closely with the Waiver Policy Technical Assistance (TA) teams to provide technical assistance with authorizations and concepts of self-determination;
Provides interpretation & implementation of Medicaid & other applicable regulations, rules & policies as a part of an overall technical assistance & training resource around self-direction. Based on policies and regulations, develop & oversee training sessions, webinar, & a variety of activities to share information, policy updates, and impacts with the field (constituents, public, people with DD & families, health care providers, CB/DD and associations) to ensure consistency, uniformity, & appropriate application across the state.
Participates in workgroups as department liaison and provides input into development of policy, goals, & objectives for the department regarding programs & initiatives, designs systems & procedures to assess outcomes. Supplies requested data & program narrative for department requests as needed.
Monitors data related to costs & services as entered by CB/DD, waiver providers, and the FMS to ensure complete & accurate systems information. Monitors and directs responses to daily inquiries around self-direction from electronic mail and telephone for technical assistance. Overseeing the follow-up technical assistance & research required for responding appropriately to issues & problems identified with the FMS system, makes resolution of such issues. Produces informational & management reports regarding self-direction for review, approval, & dissemination. Overseeing distribution of approved reports as required. Participates in systems development & provides feedback on system design & makes recommendations for system changes. Participates in system testing & provides feedback & assistance in system implementation
Coordinates & composes responses to correspondence & inquiries. Reviews work for professional presentation, accuracy of information, clarity, etc., & edits & recommends change to documents, letters, targeted for general distribution. Develop materials & presentation required for statewide, regional, & single site training & technical assistance
Coordinates with Department of Administrative Services (DAS) for the Request for Proposal (RFP) to maintain the FMS service for self-directed services in Ohio. Monitors the RFP and contract once awarded, communicates regarding the timelines for RFPs and contract compliance.
Develop material for publication, presentation, & use in technical assistance. Develops liaison relationships with existing organizations and associations in a regional area. (Ohio Self-Determination Association (OSDA) and/or any other Self-Determination groups)
Represents department, Medicaid Administration & Development (MDA), or unit at and/or attend various local, state, or national meetings, training conferences & seminars to exchange & communicate state of the art information to resolve concerns & problems which impact self-direction for people with DD. Coordinates implementation of stakeholder committees for issues related to case management services coordination as it relates to self-direction. Work collaboratively with relevant state & local agencies & other department staff in all aspects of job duties. Performs other duties as assigned.
Represents department, Medicaid Administration & Development (MDA), or unit at and/or attend various local, state, or national meetings, training conferences & seminars to exchange & communicate state of the art information to resolve concerns & problems which impact self-direction for people with DD. Coordinates implementation of stakeholder committees for issues related to case management services coordination as it relates to self-direction. Work collaboratively with relevant state & local agencies & other department staff in all aspects of job duties. Performs other duties as assigned.
***
This position is telework eligible under the agency's current telework agreement.***
What's in it for you:
A t 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.
Ohio is a Disability Inclusion State and strives to be a Model Employer of Individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
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 CoverageFree Dental, Vision and Basic Life Insurance premiums after completion of eligibility periodPaid time off, including vacation, personal, sick leave and 11 paid holidays per yearChildbirth, Adoption, and Foster Care leaveEducation and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
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 has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required. Note: education & experience is to be commensurate with approved position description on file. -If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery, incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code.
-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills:
Health Administration
Technical Skills:
Budgeting, Public Relations, Management
Professional Skills:
Attention to Detail, Verbal Communication, Reasoning
Under administrative direction from the policy manager of Medicaid Development & Administration (MDA) acts as a project/team leader to review, monitor, and manage the day to day operations of the Financial Management Service (FMS) contract that supports the Developmental Disabilities (DD) self-direction service delivery system: reviews participant-directed goods and services (PDGS) purchases; reviews other reports tracking growth and utilization of self-directed services, acts as a liaison between the county boards of developmental disabilities (CB/DD) and FMS, stakeholders and FMS to assures issues are addressed timely; coordinates monthly meetings to address concerns from county boards, stakeholders, and the FMS; reviews Monthly Pass Allocation (MPA) as needed for Self-Directed Transportation; works closely with the Waiver Policy Technical Assistance (TA) teams to provide technical assistance with authorizations and concepts of self-determination;
Provides interpretation & implementation of Medicaid & other applicable regulations, rules & policies as a part of an overall technical assistance & training resource around self-direction. Based on policies and regulations, develop & oversee training sessions, webinar, & a variety of activities to share information, policy updates, and impacts with the field (constituents, public, people with DD & families, health care providers, CB/DD and associations) to ensure consistency, uniformity, & appropriate application across the state.
Participates in workgroups as department liaison and provides input into development of policy, goals, & objectives for the department regarding programs & initiatives, designs systems & procedures to assess outcomes. Supplies requested data & program narrative for department requests as needed.
Monitors data related to costs & services as entered by CB/DD, waiver providers, and the FMS to ensure complete & accurate systems information. Monitors and directs responses to daily inquiries around self-direction from electronic mail and telephone for technical assistance. Overseeing the follow-up technical assistance & research required for responding appropriately to issues & problems identified with the FMS system, makes resolution of such issues. Produces informational & management reports regarding self-direction for review, approval, & dissemination. Overseeing distribution of approved reports as required. Participates in systems development & provides feedback on system design & makes recommendations for system changes. Participates in system testing & provides feedback & assistance in system implementation
Coordinates & composes responses to correspondence & inquiries. Reviews work for professional presentation, accuracy of information, clarity, etc., & edits & recommends change to documents, letters, targeted for general distribution. Develop materials & presentation required for statewide, regional, & single site training & technical assistance
Coordinates with Department of Administrative Services (DAS) for the Request for Proposal (RFP) to maintain the FMS service for self-directed services in Ohio. Monitors the RFP and contract once awarded, communicates regarding the timelines for RFPs and contract compliance.
Develop material for publication, presentation, & use in technical assistance. Develops liaison relationships with existing organizations and associations in a regional area. (Ohio Self-Determination Association (OSDA) and/or any other Self-Determination groups)
Represents department, Medicaid Administration & Development (MDA), or unit at and/or attend various local, state, or national meetings, training conferences & seminars to exchange & communicate state of the art information to resolve concerns & problems which impact self-direction for people with DD. Coordinates implementation of stakeholder committees for issues related to case management services coordination as it relates to self-direction. Work collaboratively with relevant state & local agencies & other department staff in all aspects of job duties. Performs other duties as assigned.
Represents department, Medicaid Administration & Development (MDA), or unit at and/or attend various local, state, or national meetings, training conferences & seminars to exchange & communicate state of the art information to resolve concerns & problems which impact self-direction for people with DD. Coordinates implementation of stakeholder committees for issues related to case management services coordination as it relates to self-direction. Work collaboratively with relevant state & local agencies & other department staff in all aspects of job duties. Performs other duties as assigned.
***
This position is telework eligible under the agency's current telework agreement.***
What's in it for you:
A t 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.
Ohio is a Disability Inclusion State and strives to be a Model Employer of Individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
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 CoverageFree Dental, Vision and Basic Life Insurance premiums after completion of eligibility periodPaid time off, including vacation, personal, sick leave and 11 paid holidays per yearChildbirth, Adoption, and Foster Care leaveEducation and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
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 has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required. Note: education & experience is to be commensurate with approved position description on file. -If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery, incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code.
-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills:
Health Administration
Technical Skills:
Budgeting, Public Relations, Management
Professional Skills:
Attention to Detail, Verbal Communication, Reasoning