Managed Care Capitation Specialist (Medicaid Health Systems Specialist) at STATE OF OHIO in Columbus, Ohio

Job Description:

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program -- one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.

Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.

A program that puts the individual first

Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions. They are:

• Emphasize a personalized care experience,


• Improve care for children and adults with complex behavioral health needs,


• Improve wellness and health outcomes,


• Support providers in better patient care and


• Increase program transparency and accountability.

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.

Office: Managed Care

Bureau: Member Services

Classification: Medicaid Health Systems Specialist (PN:20093444)

Job Overview:

As the Managed Care Capitation Specialist in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Identifies and reviews capitation payment discrepancies


• Reconciles capitation payments


• Makes initial payments as well as adjusts and recoups previously made payments


• Acts as a liaison between ODM and ODM vendors on managed care related Medicaid system changes


• Participates in system requirement review sessions and completes UAT testing for managed care related Medicaid system changes

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.

-Or 24 months experience as Medicaid Health Systems Analyst, (65291). 

-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required.

Note: education & experience to be commensurate with approved position description on file.