Medicaid Quality Control Analyst (Case Management Analyst)

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: Legal Counsel

Bureau: Program Integrity

Classification: Case Management Analyst (PN: 20042098)

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.

What You Will Do At ODM:

Office: Legal Counsel

Bureau: Program Integrity

Classification: Case Management Analyst (PN: 20042098)

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.

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.