Who We Are 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. 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. What You'll Do Office: Fiscal Operations Classification: Medicaid Health Systems Administrator 1 (PN 20047481) Job Overview: 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, your responsibilities will include: Serving as 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 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 The preferred candidates will be detail-oriented, have strong critical thinking and problem-solving skills, the ability to manage multiple priorities, and display great organizational and time management abilities. Additional Information The Ohio Department of Medicaid does not provide employment-based visa sponsorship. Compensation is as listed on the posting unless required by legislation or union contract. The work location of this position is 50 West Town Street, Columbus, Ohio 43215. You will be required to report to this work location full-time, if selected. Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.