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

Lazarus 4 (MCDLZ4)
50 West Town Street
Columbus, 43215

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.

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.

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

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.

·