Medicaid Health Systems Specialist 2
State of Ohio - Montgomery County, OH

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NOTE: This posting contains supplemental questions that will be used to assess proficiency in the minimum qualifications. Please provide complete and clear responses to each question. Applicants must receive a minimum score of 70% of the total points possible for further consideration.

Under general supervision, monitors & evaluates providers, projects, program (e.g., may include components) or service delivery by participation on or leads a team to &/or work independently to: Conduct oversight activity (e.g., review & evaluate ) to include medical & programmatic document review & face to face (e.g., may be conducted on-site) assessments &/or reassessment (e.g., questionnaires & documents to review programs) & all oversight activity of all Medicaid programs (e.g., PACE, PASSARR, Waiver) administered by other state agencies (e.g., Ohio Department of Education [ODE], Ohio Department of Health [ODH], Mental Health [MH], Ohio Department of Alcohol and Drug Assistance Services [ODADAS[, Ohio Department of Youth Services [ODYS], Ohio Department of Aging [ODA], Ohio Department of Developmental Disabilities [DODD]) & ODJFS Ohio Home Care/State Plan; reviews & evaluates medical & programmatic documents developed by contractors, county boards & providers to determine quality assurance of health & safety & clinical &/or programmatic appropriateness of services &/or payment policies.

Provides consultative expertise & training (e.g., forms completion & other non-medical training) to contractors, providers & state staff (e.g., may be conducted on-site): Uses professional medical/nursing expertise & judgment to interpret & explain federal & state laws, rules, regulations &Medicaid program policies; provides nursing input & expertise on program improvement, effectiveness & efficiency & recommends to supervisor methods of implementation, service utilization methodologies & cost saving approaches.

Operates personal computer to capture quality review data (e.g., questionnaires, surveys), to generate reports, correspondences &/or spreadsheets, databases (e.g., Data Management System, Paradox, Access) & to complete required reports (e.g., visitation, travel, time & visit summaries, unusual incidents); represents agency at conferences, meetings & workshops (e.g., participates in in-service education for state contractors, providers, other state agency staff & Ohio Medicaid Staff). testifies before state hearings &/or administrative appeals; prepares complex technical reports for program oversight, contract management & quality assurance; responds to inquiries by consumers, providers, county agencies & government officials by telephone, correspondence &/or in person.).

Performs other related duties (e.g., limited related administrative duties; attends staff meetings & seminars; travels to meeting sites; maintains records logs & files while maintaining client & provider confidentiality

Minimum Qualifications:

Note: education & experience to be commensurate with approved position description on file.

-For positions 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 42 mos. exp. in nursing.

-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Major Worker Characteristics:

Knowledge of social or behavioral science or pre-medicine or comparable field; business administration; federal & state laws & regulations; agency policies & procedures; health care statistics, terminology & methods; public relations; public medical assistance programs; purchasing & payment practices of health care services; payment/pricing strategies; nursing. Skill in operating personal computer & applicable software applications (e.g., word processing; spreadsheet; databases). Ability to analyze multiple factors, apply factors & present findings & conclusions; read & comprehend clinical records; determine level of care; determine accuracy assessments & data; assess & monitor quality assurance & corrective action plans; prepare comprehensive & technical reports; interpret social welfare information & technical materials in books, journals & manuals; perform complex algebraic formulas; read & comprehend clinical records & residence &/or clinical data &/or quality assurance/corrective action plans to make appropriate assessments/referrals &/or to determine level of care & need; prepare review &/or evaluate records, reports, clinical assessments/data &/or financial/grant documents; handle routine & sensitive contacts with & inquiries from public, consumers, providers, & government officials in person, via telephone &/or through written correspondence.

Supplemental Information:

"Note: Attachments are not accepted for this posting but you may copy and paste a text resume on the application."

This position is headquartered in Montgomery County. The selected applicant will be required to begin and end their scheduled work day at this headquartered location. No exceptions will be allowed.

Current & valid license to practice professional Nursing as a registered Nurse (i.e. RN) in Ohio as issued by Board of Nursing pursuant to Sections 4723.01 to 4723.40, inclusive of Ohio Revised Code.

TRAININGS AND DEVELOPMENT REQUIRED TO REMAIN IN CLASSIFICATION AFTER EMPLOYMENT, Biennial renewal of license to practice as registered nurse per Section 4723.24 of Ohio Revised Code.

***Non standard work week includes evening, early morning and travel hours equal to 40 hours per week.


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The Ohio State University at Marion serves as one of five regional campuses to the Columbus main campus. As a regional campus, Marion...