Compliance Review Manager - PN 20090769 (Medicaid Health Systems Administrator 1)

Who We Are 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'll Do Office: Operations Classification: Medicaid Health Systems Administrator 1 (PN 20090769) Bureau: Network Management Job Overview: The Ohio Department of Medicaid (ODM) is seeking a Health Systems Administrator to join the Home and Community Based Services (HCBS) Waiver Provider Oversight team to oversee provider compliance with Conditions of Participation for the Ohio Home Care and MyCare Ohio waiver programs. As the Compliance Review Manager, your key responsibilities will be: Drafting proposed adjudication orders and application denial letters. Conducting quality assurance reviews of waiver provider structural reviews for independent providers. Analyzing waiver provider performance data to evaluate compliance and identify opportunities for continuous quality improvement. Responding to inquiries from waiver providers, provider advocates, internal ODM staff and partner state agencies. Collaborating with internal and external stakeholders to support waiver program operations, compliance activities, and policy implementation. The ideal candidate is a detail-oriented, analytical professional who applies critical thinking and data-driven decision-making to complex challenges while delivering accurate, high-quality results. They excel at managing competing priorities, communicating effectively, collaborating with diverse stakeholders, and continuously expanding their knowledge to support program success. Additional 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.