Provider Engagement Manager

Primary Location : United States of America-OHIO-Franklin County-Columbus Work Locations : Lazarus 4 50 West Town Street Columbus 43215 Organization : Ohio Department of Medicaid Classified Indicator : Classified Bargaining Unit / Exempt : Exempt Schedule : Full-time Work Hours : 8:00AM - 5:00PM Compensation : $33.69/hour Unposting Date : May 10, 2022, 10:59:00 PM Job Function : Health Administration Job Level : Manager / Supervisor Agency Contact Name : ODM Human Resources Agency Contact Information : HumanResources@medicaid.ohio.gov

Provider Engagement Manager

(22000400) Job Duties

This position may be telework eligible on a hybrid basis; the selected applicant must complete the initial training period prior to being eligible to telework. All requests to telework are reviewed on a case-by-case basis and must be approved by ODM’s Chief Human Resources Officer.

About Us:

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program - focusing on the individual rather than the business of managed care.

The goals of the next generation of Ohio Medicaid are:

• Emphasize a personalized care experience
• Improve care for children and adults with complex behavioral health needs
• Improve wellness and health outcomes
• Support providers in better patient care and
• Increase program transparency and accountability

What You Will Do at ODM:

Working Title: Provider Engagement Manager

Office: Operations

Bureau: Business Operational Support, Provider Relations

Classification: Medicaid Health Systems Administrator 1 (PN 20097102)

As a Provider Engagement Manager on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:

• Manage the provider claim dispute resolution process
• Review and approve all Provider Claim Dispute Resolution policies
• Supervise, train, and develop Provider Engagement Specialists
• Resolve escalated non-institutional MCE and FFS provider inquiries
• Ensure MCE (Managed Care Entity) compliance
• Attend internal and external MCE and FFS (Fee-for-Service) oversight meetings
• Participate in Provider Advisory Council (PAC) meetings
• Work collaboratively with internal and external stakeholders to improve provider engagement and the healthcare delivery system
• Participate in provider engagement activities such as attend seminars, deliver presentations, and review provider training material

What’s in it for you:

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 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.

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 as a Medicaid Health Systems Specialist, 65293.

Note: education & experience is to be commensurate with approved position description on file.

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

Supplemental Information:

Compensation is as listed on the posting unless required by legislation or union contract.

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.

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.

Background Check Information

The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.