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Role Summary

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HIGHLIGHTS

Manager-level Health rate setting role in Ohio Medicaid’s Managed Care Rate Setting (MCRS) team in Columbus, OH. You will develop and validate Medicaid capitation rates, liaise with MCOs and the State actuary, monitor MCO financial performance, and ensure CMS reporting and compliance. This role focuses on Medicaid capitation pricing and program financial administration.

JOB DESCRIPTION SUMMARY

  • Develop and administer Medicaid MMC capitation premium rates
  • Serve as liaison with seven MCOs and the State's actuary
  • Ensure CMS reporting compliance including rate certifications and MLR
  • Monitor MCO financial performance and healthcare expense data
  • Manage loading of capitation rates into the State payment system

DOMAIN EXPERTISE

  • HMO and hospital rate development
  • Health care data analysis
  • Health services contract management
  • Health services budget development
  • Health services program or project management

KEY REQUIREMENTS

  • Completion of a graduate core program in business/health/public administration OR 12 months relevant experience
  • Minimum 12 months experience in health services program delivery or project management
  • Experience with HMO and hospital rate development and health care financial analysis
  • Ability to manage multiple priorities and detailed compliance/reporting tasks

TECH STACK

  • No tech stack specified
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Role Summary

Loading...

HIGHLIGHTS

Manager-level Health rate setting role in Ohio Medicaid’s Managed Care Rate Setting (MCRS) team in Columbus, OH. You will develop and validate Medicaid capitation rates, liaise with MCOs and the State actuary, monitor MCO financial performance, and ensure CMS reporting and compliance. This role focuses on Medicaid capitation pricing and program financial administration.

JOB DESCRIPTION SUMMARY

  • Develop and administer Medicaid MMC capitation premium rates
  • Serve as liaison with seven MCOs and the State's actuary
  • Ensure CMS reporting compliance including rate certifications and MLR
  • Monitor MCO financial performance and healthcare expense data
  • Manage loading of capitation rates into the State payment system

DOMAIN EXPERTISE

  • HMO and hospital rate development
  • Health care data analysis
  • Health services contract management
  • Health services budget development
  • Health services program or project management

KEY REQUIREMENTS

  • Completion of a graduate core program in business/health/public administration OR 12 months relevant experience
  • Minimum 12 months experience in health services program delivery or project management
  • Experience with HMO and hospital rate development and health care financial analysis
  • Ability to manage multiple priorities and detailed compliance/reporting tasks

TECH STACK

  • No tech stack specified

Job Overview

Salary
Salary not specified
Years of Experience
1+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Manager-level health administration professional with Medicaid managed care experience, strong HMO/hospital rate development or financial analysis background, and proven skills in stakeholder liaison and regulatory compliance.

Benefits

Health InsuranceDental InsuranceVision InsuranceLife InsurancePaid Sick LeaveGenerous VacationPaid Parental Leave401(k) PlanTraining Budget
Fresh Role
Premium Window
3d
3 days ago

Strategy: Maximize Application Quality

Applications submitted within 72 hours are 2x more likely to land an interview.

"Recruiters are actively watching. Take time to tailor your keywords."

Job Overview

Salary
Salary not specified
Years of Experience
1+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Manager-level health administration professional with Medicaid managed care experience, strong HMO/hospital rate development or financial analysis background, and proven skills in stakeholder liaison and regulatory compliance.

Benefits

Health InsuranceDental InsuranceVision InsuranceLife InsurancePaid Sick LeaveGenerous VacationPaid Parental Leave401(k) PlanTraining Budget
Fresh Role
Premium Window
3d
3 days ago

Strategy: Maximize Application Quality

Applications submitted within 72 hours are 2x more likely to land an interview.

"Recruiters are actively watching. Take time to tailor your keywords."

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Ohio Department of Aging

Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administrator 1)

Ohio Department of Aging•Columbus, United States•3d ago
MedicaidPricing & RatingRegulatory ReportingUW Support & Portfolio Management