Ohio Benefits Program Specialist - PN 20096292 (Medicaid Health Systems Specialist)

State-of-Ohio; Columbus (OH); On-site; USD 41,000 - 58,000; Full time

Job summary

Ohio Department of Medicaid in Columbus, OH is seeking an experienced Health Systems Specialist (RN) to support managed care operations within the Ohio Benefits platform. You will analyze system issues, assess impacts on Medicaid eligibility, and coordinate with vendors and internal teams to implement fixes.

The role requires a current RN license and at least 24 months of nursing experience. This is a full-time, permanent position with standard business hours in a centralized state office.

Qualifications

• Current and valid RN license in Ohio.
• Minimum 24 months nursing experience or related healthcare work.
• Education and experience commensurate with the position description.

Responsibilities

• Analyze reported system problems affecting Medicaid eligibility workflows.
• Evaluate impact on eligibility determinations and data sharing.
• Collaborate with internal program areas to align system operations with Medicaid policy.
• Communicate with system vendors with detailed issue descriptions and steps.
• Participate in vendor meetings and system review sessions to monitor progress.
• Review vendor solutions and updates for policy alignment and operational needs.
• Monitor defects, enhancements, and performance issues using tracking tools.
• Assist in user acceptance testing with test scenarios and validated fixes.
• Prepare reports and status updates for leadership on trends, risks, and actions.

Skills

Health Administration

Education

Registered nurse license

Job description

All job postings will expire at 11:59 PM Eastern Time on the application deadline.

Organization: Medicaid

Agency Contact Name and Information: [e-mail]

Work Location:

50 West Town Street

Columbus, Ohio, 43215

United States

Compensation: $36.01

Schedule: Permanent - Full Time

Work Hours: 8:00AM - 5:00PM

Classified Indicator: Classified

Union: 1199

Primary Job Skill: Health Administration

Who We Are

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.

What You'll Do

Office: Managed Care

Bureau: Member Services

Classification: Medicaid Health Systems Specialist(PN: 20096292)

Job Overview:

As the Ohio Benefits Program Specialist in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Analyze reported system (Ohio Benefits - OB, Fiscal Intermediary - FI, and Provider Network Management - PNM) problems from providers to determine impact on Medicaid eligibility workflows, and priority level for resolution.
• Evaluate the impact of system issues and changes on eligibility determinations, provider interactions, and downstream data sharing processes.
• Collaborate with internal program areas to ensure accurate representation of Medicaid policy within system operations.
• Communicate regularly with system vendors, providing detailed issue descriptions, replication steps, and supporting documentation to facilitate timely troubleshooting and defect resolution.
• Participate in vendor meetings, technical workgroups, and system review sessions to support issue resolution and progress monitoring.
• Review vendor proposed solutions, design documents, and system updates to ensure alignment with Medicaid rules, policy intent, and operational needs.
• Monitor, track, and document Ohio Benefits system defects, enhancements requests, and performance issues using established issue tracking tools and processes.
• Assist in user acceptance testing (UAT) by developing test scenarios, validating fixes, and confirming successful implementation prior to production release.
• Prepare reports, summaries, and status updates for leadership, documenting issue trends, resolution timelines, risks, and recommended actions.

Additional Information

The Ohio Department of Medicaid does not provide employment-based visa sponsorship.

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

The work location of this position is 50 West Town Street, Columbus, Ohio 43215. You will be required to report to this work location full-time, if selected.

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.

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:

Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code additional 24 mos. exp. in nursing.

• -Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
• -Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
• -Or for positions other than those requiring valid license as registered nurse, equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Job Skills: Health Administration

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.