Provider Compliance Manager (Medicaid Health Systems Administrator 1)

What You Will Do At ODM Office: Operations Bureau: Network Management Classification: Medicaid Health Systems Administrator 1 (PN 20102829) Job Overview The Ohio Department of Medicaid is seeking a compliance professional to be a part of our Network Management team. As a provider compliance team member your responsibilities will include: Developing and managing documentation for Administrative, State, and Federal criminal cases and testifying. Monitoring Federal and State policy and regulations to ensure Medicaid provider compliance. Developing and overseeing procedures to support Federal and State Policy based on program initiatives. Overseeing the notification of proper entities of provider closures (e.g., Sister Agencies, Managed Care Entities, Clinical) to ensure member safety and continuity of care. Receiving correspondence from State and federal entities regarding credible allegations of fraud, indictments, convictions, exclusions, investigations etc. and making determinations based on information received for next steps. Working closely with ODM legal and other internal partners to make recommendations (e.g., suspension or termination of provider contracts) Respond to requests for state and federal audits. Managing state and federal data bases. The preferred candidate will have considerable computer systems experience and the strong ability to interpret and operationalize Federal and State policy. Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a 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 base analysis). Or 12 months experience has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required. Note: education & experience is to be commensurate with approved position description on file. -If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery, incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code. Or 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 Agency Contact Name and Information View email address on click.appcast.io Unposting Date: Aug 24, 2026, 9:29:00 AM Work Location: Lazarus 4 Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $40.40/hour Schedule: Full-time Work Hours: 8:00 am - 5:00 pm Classified Indicator: Classified Union: Exempt from Union Technical Skills: Health Administration, Compliance Enforcement Professional Skills: 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. Responsibilities 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. #J-18808-Ljbffr Ohio Department of Medicaid