Medicaid Health Systems Specialist - RN

What You Will Do At ODM

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN 20047592)

Job Overview

The Registered Nurse (RN) in this position will:

• Utilize the Ohio Administrative Code (OAC), and Federal rules, policies, and procedures to make clinical/medical based definitive decisions to determine disability
• Review and evaluate medical records and statistical reports
• Frequently use electronic medical documentation and software applications, interact with providers, other agencies and external stakeholders
  
  

Position 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 24 mos. exp. in nursing.

• Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
• Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) 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.
  
  

Job Skills: Health Administration

Organization

Medicaid

Agency Contact Name and Information

HumanResources@medicaid.ohio.gov

Unposting Date

Mar 12, 2025, 10:59:00 PM

Work Location

Lazarus 4

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$33.45/hour

Schedule

Full-time

Work Hours

8:00 am - 5:00 pm

Classified Indicator

Classified

Union

1199

Primary Job Skill

Health Administration

Technical Skills

Health Administration, Nursing

Professional Skills

Interpreting Data

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.