Provider Network and Data Oversight Specialist (Health Services Policy Specialist)

What You Will Do At ODM:

Office: Managed Care

Bureau: Managed Care Compliance & Oversight

Classification: Health Services Policy Specialist (PN: 20102013)

Job Overview:

As Provider Network and Data Oversight Specialist, your will be responsible to:

• Lead for managed care provider data management and provider network standard methodologies
• Manage provider network reporting for managed care organizations (MCOs)/ MyCare Ohio plans (MCOP)
• Assist with oversight of provider network management (PNM) module for Managed Care
• Assist in communication of data
• MCO/ MCOP provider enrollment liaison
• MCO/ MCOP lead for the managed care network provider reconciliation files
• Monitor Provider Agreement (PA)/ Code of Federal Regulations (CFR) Compliance
• Monitor and review MCO/ MCOP directories for compliance with PA (data specifically)

Completion of graduate core coursework in health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.

• Or completion of undergraduate core coursework & 12 mos. exp. in one of following: health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics, public health, or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis, graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
• Or 2 yrs. exp. as Health Services Analyst, 65211.
• Or equivalent of Minimum Class Qualifications For Employment noted above.

Job Skills: Data Analytics

Technical Skills: Health Administration, Data Modeling, Data Visualization

Professional Skills: Analyzation, Attention to Detail, Collaboration, Innovation