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

Ohio Department of Medicaid; Columbus (OH); On-site; USD 82,000 - 86,000; Full time

Job summary

Ohio Department of Medicaid is seeking an experienced professional to join the Nursing Facility Long-Term Care Rate Setting Team. The NF LTC Rate Setting Manager will oversee rate development, data analysis, and related policy work within OMES to support Ohio’s NF reimbursement program.

Responsibilities include developing semi-annual NF rates, reviewing legislative proposals, and collaborating with Policy, Budget, Data Governance, and LTC Enrollment teams.

Qualifications

• Graduate core program in business, management or public administration; public health, health administration, social or behavioral science or public finance experience.
• 12 months’ experience in delivering a health services program or health services project management.
• Experience as Medicaid Health Systems Specialist or equivalent, commensurate with position description on file.
• Equivalent of Minimum Class Qualifications for Employment.

Responsibilities

• Develop semi-annual NF rates and manage rate adjustments.
• Perform data analysis on NF claims, cost reports, and related calculations.
• Maintain NF rate setting components within OMES.
• Review legislative proposals, inquiries, statutes, and rules related to NF rates.
• Collaborate with Policy, Budget, Data Governance, Fiscal, and LTC Enrollment teams.
• Manage the NF Private Room Incentive Program and monitoring claims.
• Monitor NF enrollment, MDS trends, cost report patterns, and beds.
• Respond to inquiries from NF associations and providers.

Skills

Health Administration

Collaboration

Critical Thinking

Problem Solving

Innovation

Education

Graduate core program in business, management or public administration

Job description

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.

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

Agency Contact Name and Information

[e-mail]

Unposting Date

Oct 12, 2026, 11:59:00 AM

Work Location

Lazarus 5

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$40.40/hour

Schedule

Full-time

Work Hours

8:00 am - 5:00 pm

Classified Indicator

Classified

Union

Exempt from Union

Technical Skills

Program Management, Public Health

Professional Skills

Collaboration, Critical Thinking, Innovation, Problem Solving

Agency Overview

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.

Responsibilities

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.