Managed Care Rate Setting Healthcare Manager (Medicaid Health Systems Administrator 1)
MedicaidPricing & RatingRegulatory ReportingUW Support & Portfolio Management
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
