Medicaid Quality Control Analyst (Case Management Analyst)

Taleo; Columbus (OH); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical Coverage

Paid time off

Education opportunities

Public retirement benefits

Job summary

Ohio Department of Medicaid seeks a Medicaid Quality Control Analyst to join the Eligibility Quality Control unit. You will perform quality reviews of Medicaid eligibility determinations made by county agencies to ensure timeliness and accuracy statewide.

The role requires strong analytical skills, attention to detail, and experience with Medicaid programs. Full-time position in Columbus with comprehensive state benefits and union representation.

Qualifications

• Undergraduate coursework in social and/or behavioral science; 12 months’ training or experience in public assistance regulations and policies.
• 3 months’ training or 3 months’ experience in technical writing; 3 months’ training or 3 months’ experience in mainframe databases; valid Ohio driver’s license.
• Equivalent minimum qualifications for employment.

Responsibilities

• Conduct comprehensive case reviews of county CDJFS records to determine Medicaid eligibility.
• Review approvals/denials of randomly selected CHIP and Medicaid cases for accuracy.
• Analyze automated systems to ensure compliance with federal and state rules.
• Verify all aspects of eligibility by reviewing records, verifications, and system actions.
• Provide final determinations and communicate results and analysis of reviews.

Skills

Health Administration

Attention to Detail

Collaboration

Interpreting Data

Results Oriented

Verbal Communication

Written Communication

Job description

Job Description - Medicaid Quality Control Analyst (Case Management Analyst) (260007CN)

Medicaid Quality Control Analyst (Case Management Analyst) ( 260007CN )

Organization

Medicaid

Agency Contact

[e-mail]

Unposting Date

Oct 15, 2026, 3:59:00 AM

Work Location

Lazarus 4 50 West Town Street Columbus 43215

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation : $$31.47/hour

Schedule

Full-time

Union : OCSEA

Primary Job Skill

Health Administration

Technical Skills : Health Administration

Professional Skills : Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication

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.

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.

Job Description

What You Will Do At ODM:

Office: Legal Counsel

Bureau: Program Integrity

Classification: Case Management Analyst (PN: 20042098 )

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to be part of our Medicaid Eligibility Quality Control (MEQC) unit. This person will complete quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services, to ensure timeliness and accuracy statewide. As a Medicaid Quality Control Analyst, your responsibilities will include:

• Conducting comprehensive case reviews of County Departments of Job and Family Services (CDJFS) and other participating agencies’ records that determine eligibility for Medicaid programs.


• Reviewing approval/denials of random selected CHIP and Medicaid cases to evaluate the eligibility determination accuracy.


• Analyzing automated computer information systems to ensure county compliance with federal and state rules, regulations, and policies.


• Verifying all aspects of Medicaid eligibility by reviewing case record information, electronic verifications, and eligibility system actions.


• Making a final determination at the conclusion of the case review findings and providing results and analysis of reviews.


• Ensuring compliance with federally mandated MEQC rules and regulations.


• Communicating with ODM leadership about issues identified during reviews.

The preferred candidate will have a background in Medicaid eligibility and possess strong analytical skills with attention to detail.

Why Work for the State of Ohio

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:

• Medical Coverage


• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period


• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year


• Childbirth, Adoption, and Foster Care leave


• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)


• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

• Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.


• Or 36 mos. exp. as public assistance caseworker, with experience in all categories of public assistance; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.


• Or equivalent of Minimum Class Qualifications for Employment noted above.

Technical Skills: Health Administration

Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication

Supplemental Information

Supplemental Information:

Compensation is as listed on the posting unless required by legislation or union contract.

Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.