What are the responsibilities and job description for the Medicaid Quality Control Analyst (Case Management Analyst) position at Ohio Department of Medicaid?
What You Will Do At ODM
Office: Legal Counsel
Bureau: Program Integrity
Classification: Case Management Analyst (PN: 20042095)
Job Overview
The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to be part of our Medicaid Eligibility Quality Control (MEQC) unit. This person will complete quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services, to ensure timeliness and accuracy statewide. As a Medicaid Quality Control Analyst, your responsibilities will include:
Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.
Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication
Organization
Medicaid
Agency Contact Name and Information
HumanResources@medicaid.ohio.gov
Unposting Date
Mar 6, 2025, 11:59:00 PM
Work Location
Lazarus 4
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$29.23/hour
Schedule
Full-time
Work Hours
8:00 am - 5:00 pm
Classified Indicator
Classified
Union
OCSEA
Primary Job Skill
Health Administration
Technical Skills
Health Administration
Professional Skills
Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication
Agency Overview
THE WORK LOCATION OF THIS POSITION IS 50 WEST TOWN STREET, COLUMBUS, OHIO 43215. YOU WILL BE REQUIRED TO REPORT TO THIS WORK LOCATION, IF SELECTED.
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:
Office: Legal Counsel
Bureau: Program Integrity
Classification: Case Management Analyst (PN: 20042095)
Job Overview
The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to be part of our Medicaid Eligibility Quality Control (MEQC) unit. This person will complete quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services, to ensure timeliness and accuracy statewide. As a Medicaid Quality Control Analyst, your responsibilities will include:
- Conducting comprehensive case reviews of County Departments of Job and Family Services (CDJFS) and other participating agencies’ records that determine eligibility for Medicaid programs.
- Reviewing approval/denials of random selected CHIP and Medicaid cases to evaluate the eligibility determination accuracy.
- Analyzing automated computer information systems to ensure county compliance with federal and state rules, regulations, and policies.
- Verifying all aspects of Medicaid eligibility by reviewing case record information, electronic verifications, and eligibility system actions.
- Making a final determination at the conclusion of the case review findings and providing results and analysis of reviews.
- Ensuring compliance with federally mandated MEQC rules and regulations.
- Communicating with ODM leadership about issues identified during reviews.
Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.
- Or 36 mos. exp. as public assistance caseworker, with experience in all categories of public assistance; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.
- Or equivalent of Minimum Class Qualifications for Employment noted above.
Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication
Organization
Medicaid
Agency Contact Name and Information
HumanResources@medicaid.ohio.gov
Unposting Date
Mar 6, 2025, 11:59:00 PM
Work Location
Lazarus 4
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$29.23/hour
Schedule
Full-time
Work Hours
8:00 am - 5:00 pm
Classified Indicator
Classified
Union
OCSEA
Primary Job Skill
Health Administration
Technical Skills
Health Administration
Professional Skills
Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication
Agency Overview
THE WORK LOCATION OF THIS POSITION IS 50 WEST TOWN STREET, COLUMBUS, OHIO 43215. YOU WILL BE REQUIRED TO REPORT TO THIS WORK LOCATION, IF SELECTED.
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.
Salary : $29
