Utilization Management Section Chief - RN (Medicaid Health Systems Administrator 2 - RN)

Ohio Department of Public Safety; Columbus (OH); On-site; USD 90,000 - 95,000; Full time

Job summary

Ohio Department of Medicaid seeks a RN Utilization Management Section Chief to lead clinical operations and drive quality across programs. You will work under clinical direction to oversee UM processes, reports, and vendor management within the Health Innovation & Quality Office.

The role requires a registered nurse license in Ohio, a graduate degree in a health-related field, and 2 years of health services management experience.

Qualifications

• Graduate degree in health administration, public health, business or public administration.
• 24 months experience in planning or administering health services programs or health services project management.
• Current and valid RN license in Ohio.

Responsibilities

• Oversee UM clinical operations, technology, quality and regulatory oversight to advance ODM objectives.
• Manage two teams of nurses and oversee UM of vendor and managed care entities.
• Develop reports to monitor goals of overall utilization management across ODM programs.
• Oversee day-to-day operational activities of the Utilization Management Program.
• Develop and maintain policies and procedures for authorization processes and monitoring.

Skills

Nursing

Health Administration

Collaboration

Critical Thinking

Decision Making

Leading Others

Education

Graduate degree in health administration / public health / business or public administration

Job description

Organization

Medicaid

Agency Contact

[e-mail]

Work Location

Lazarus 4 50 West Town Street Columbus 43215

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$44.38/hour

Schedule

Full-time

Union

Exempt from Union

Primary Job Skill

Nursing

Technical Skills

Health Administration, Nursing

Professional Skills

Collaboration, Critical Thinking, Decision Making, Goal Setting, Interpreting Data, Leading Others, Managing Meetings, Motivating Others, Organizing and Planning, 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: Health Innovation & Quality

Bureau: Clinical Operations/Utilization Management

Classification: Medicaid Health Systems Administrator 2 (PN: 20086630)

Job Overview: As the Utilization Management Section Chief - RN in the Office of Health Innovation & Quality, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Working under the Bureau Chief of Clinical Operations and the clinical direction of ODM's Medical Directors.
• Provide oversight to the processes of identifying, managing, and tracking UM clinical operations, technology, quality, and regulatory oversight to advance the objectives of ODM.
• Manage two teams of nurses and oversee UM of vendor and managed care entities.
• Develop reports to support and monitor goals of overall UM, across ODM programs.
• Oversee day to day operational activities of the Utilization Management Program across ODM programs
• Develop and maintaining written policies and procedures regarding authorization processes and monitoring of utilization management.
• Ensure the consistent application of review criteria across ODM programs.
• Ensure decisions to deny or reduce the amount of services are made by a health care professional who has appropriate clinical expertise in treating members.
• Ensure notices of adverse action are provided and meet requirements across ODM programs.
• Ensure authorization decisions are made within allowable timeframes.
• Evaluate under and over utilization information for impact on member care, health outcomes, and access to care.
• Assist with the development and implementation of comprehensive onboarding and ongoing training

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 graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 24 mos. exp. in planning & administering 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 analysis); Current and valid license to practice professional nursing as a Registered Nurse (RN) in the State of Ohio, issued by the Ohio Board of Nursing pursuant to Sections 4723.01 through 4723.40 of the Ohio Revised Code.

• -Or for positions requiring valid license as registered nurse, 24 months experience as a Medicaid Health Systems Administrator 1, (65295) may be substituted for the experience required, but not for the mandated licensure.
• -Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Technical Skills: Nursing; Health Administration

Professional Skills: Critical Thinking, Collaboration, Goal setting, Interpreting Data, Leading Others, Managing Meetings, Organizing and Planning, Decision Making, Motivating Others, Verbal Communication, Written Communication

Supplemental Information

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

This position is overtime exempt.

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.