Disability Determination Nurse (Medicaid Health Systems Specialist - RN)

Ohio; Columbus (OH); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a skilled Medicaid Health Systems Specialist to join their Operations team. In this role, you will utilize your clinical expertise to make informed decisions regarding disability determinations and Medicaid service delivery. Your responsibilities will include reviewing medical records and interacting with providers and stakeholders using advanced electronic documentation. This position offers a unique opportunity to impact health administration positively while working in a collaborative environment that values your contributions. If you are passionate about making a difference in healthcare, this role is for you.

Qualifications

• Must hold a valid RN license with 24 months of nursing experience.
• Alternatively, an undergraduate degree in a related field with relevant experience.

Responsibilities

• Make clinical decisions based on OAC and federal rules.
• Review medical records and evaluate statistical reports.

Skills

Health Administration

Clinical Decision Making

Electronic Medical Documentation

Statistical Analysis

Education

Registered Nurse License

Undergraduate Degree in Health or Business

Tools

Spreadsheet Software

Database Software

Job description

What You Will Do at ODM:

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN 20047592)

Job Overview:

The Registered Nurse (RN) in this position will:

1. Utilize the Ohio Administrative Code (OAC), and Federal rules, policies, and procedures to make clinical/medical-based definitive decisions to determine disability.
2. Review and evaluate medical records and statistical reports.
3. Frequently use electronic medical documentation and software applications, interact with providers, other agencies, and external stakeholders.

This position requires assessment or reassessment of the clinical appropriateness of services, payment policies, or related issues concerning Medicaid health services delivery. Candidates must have:

• A current and valid license as a registered nurse issued by the Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of the Ohio Revised Code, along with at least 24 months of nursing experience.
• Alternatively, for positions not requiring a registered nurse license: completion of an undergraduate core program in business administration, social or behavioral science, health, or statistics, plus 24 months of experience in the specific subject area, including at least 12 months of experience using spreadsheet and database software.
• Or, 24 months of experience as a Medicaid Health Systems Analyst (65291), which may substitute for the experience requirement but not for the licensure.
• Or, an equivalent combination of minimum class qualifications for employment can substitute for the experience, but not for the licensure.

Job Skills: Health Administration