Provider Compliance Manager (Medicaid Health Systems Administrator 1)

Job Description - Provider Compliance Manager (Medicaid Health Systems Administrator 1) (260005PS) Provider Compliance Manager (Medicaid Health Systems Administrator 1) ( 260005PS ) Organization Medicaid Agency Contact Name and Information : View email address on click.appcast.io Unposting Date Aug 24, 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 : $40.40/hour Schedule Full-time Union : Exempt from Union Primary Job Skill Health Administration Technical Skills : Health Administration, Compliance Enforcement 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: 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. 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; 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 Supplemental 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. 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. #J-18808-Ljbffr State of Ohio