Long-Term Care Rate Setting Manager (Medicaid Health Systems Administrator 1)

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.

What You Will Do at ODM:

Office: Policy

Bureau: Long Term Services & Supports

Classification: Medicaid Health Systems Administrator 1 (PN 20047434)

 
Job Overview:

The Ohio Department of Medicaid (ODM) is seeking an experienced professional to join the Nursing Facility (NF) Long-Term Care (LTC) Rate Setting Team. This team is responsible for developing, maintaining, and analyzing NF reimbursement rates, as well as supporting related operational, policy, and regulatory functions. This role will oversee rate development and the analytical, operational, and policy work that supports Ohio’s NF reimbursement program. As the NF LTC Rate Setting Manager, your responsibilities will include:

• Developing semi-annual NF rates and managing rate adjustments throughout the year (e.g. CHOW/CHOP updates, new facilities, and rate reconsiderations).
• Performing data analysis related to NF claims, cost reports, franchise permit fee, and upper payment limit calculations.
• Maintaining and operating NF rate setting components within the Ohio Medicaid Enterprise System (OMES).
• Reviewing legislative proposals, inquiries, statutes, and rules related to NF rates, providing feedback, cost estimates, and budget projections.
• Collaborating with teams across Policy, Budget, Data Governance, Fiscal, Franchise Permit Fee, and LTC Enrollment to ensure consistent communication and alignment on rate related initiatives.
• Managing the NF Private Room Incentive Program (e.g. rule review, application approvals and denials, attestation processes, and monitoring claims to ensure spending remains within the cap).
• Monitoring NF enrollment, MDS trends, cost report patterns, Medicaid days, licensed beds, and other key data to support projections and policy development.
• Responding to inquiries from NF associations, managed care plans, and providers regarding NF rates.
   

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


• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period


• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year


• Childbirth, Adoption, and Foster Care leave


• Education 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.

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.

This position is overtime exempt.

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.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

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

-Or equivalent of Minimum Class Qualifications for Employment. 

Job Skills: Health Administration

Technical Skills: Public Health, Program Management

Professional Skills: Collaboration, Innovation, Critical Thinking, Problem Solving

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.

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.