Managed Care Rate Strategy Lead

State of Ohio; Columbus (OH); On-site; USD 46,000 - 65,000; Full time

Job summary

The Ohio Department of Medicaid is seeking an experienced healthcare administrator to join the Managed Care Rate Setting team in Columbus, OH. This full-time, permanent role focuses on developing premium rates for MMC capitation and coordinating with MCOs and actuaries to ensure compliant rate setting.

The ideal candidate will have a graduate degree in health administration or related field and at least 12 months of health services program management experience, with strong analytical and

Qualifications

• Graduate degree in business, management or public administration, public health, health administration, social or behavioral science or public finance.
• 12 months of experience delivering a health services program or health services project management.
• May substitute Medicaid Health Systems Specialist experience for the required experience.
• If overseeing clinical appropriateness or payment policies, must have a current RN license.

Responsibilities

• Serve as liaison between MCOs, actuary, and stakeholders in MMC capitation rate development.
• Monitor MCO financial performance with the actuary.
• Ensure CMS reporting requirements are met, including rate certifications and MLR reporting.
• Manage loading of MMC capitation rates into the State's payment system.
• Monitor healthcare expense data and track program changes affecting rates.
• Support inquiries from plans, providers, and legislative groups.

Skills

Health Administration

Education

Graduate degree in business, management, public administration, health administration, or public health

Job description

The Ohio Department of Medicaid is seeking an experienced healthcare administrator to join the Managed Care Rate Setting team in Columbus, OH. This full-time, permanent role focuses on developing premium rates for MMC capitation and coordinating with MCOs and actuaries to ensure compliant rate setting.

The ideal candidate will have a graduate degree in health administration or related field and at least 12 months of health services program management experience, with strong analytical and