Clinical Review Manager (Medicaid Health Systems Administrator 1)

What You Will Do At ODM:

Office: Health Innovation & Quality

Bureau: Clinical Operations

Classification: Medicaid Health Systems Administrator 1 (PN 20047504)

Job Overview:

As the Clinical Review Manager in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Planning, coordinating and monitoring oversight activities for Medicaid programs
• Assisting in developing program monitoring initiatives designed to evaluate and assess program compliance for state and federal requirements with a focus on health and safety and care management activities
• Assisting with oversight of both internal and external reviews measuring program performance for various Medicaid Programs (e.g., Home and Community Based Waivers, Specialized Recovery Services Program, and managed care)
• Serving as the Bureau of Clinical Operations coordinator for the External Quality Review Organization (EQRO) activities
• Reviewing, analyzing, and interpreting data (e.g., survey results) and reports and provide recommendations for follow-up activities related to program performance
• Working collaboratively with internal and external stakeholders across a variety of departments, levels, and state agencies to conduct and develop oversight activities

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.
• Or equivalent of Minimum Class Qualifications for Employment noted above.

Job Skills: Health Administration

Technical Skills: Formulating and implementing policies and procedures, Collaborating

Professional Skills: Consultation, Collaboration, Attention to Detail, Priority Setting, Decision Making, Verbal Communication, Written Communication, Goal Setting, Problem Solving