Medicaid Quality Control Analyst (Case Management Analyst)

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:

• 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.

The preferred candidate will have a background in Medicaid eligibility and possess strong analytical skills with attention to detail.

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.

Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication

Supplemental Information:

Compensation is as listed on the posting unless required by legislation or union contract.

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.

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.

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.