Disability Determination Nurse (Medicaid Health Systems Specialist

Disability Determination Nurse (Medicaid Health Systems Specialist - RN) (250003JN)

Disability Determination Nurse (Medicaid Health Systems Specialist - RN)

(250003JN)

Organization: Medicaid

Agency Contact Name and Information: ...

Unposting Date: May 11, 2025, 9:59:00 PM

Work Location: Lazarus 4 50 West Town Street Columbus 43215

Primary Location: United States of America-OHIO-Franklin County-Columbus

Compensation: $33.45/hour

Schedule: Full-time

Work Hours: 8:00 am - 5:00 pm

Classified Indicator: Classified

Union: 1199

Primary Job Skill: Nursing

Technical Skills: Nursing

Professional Skills: Interpreting Data

Agency Overview

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.

Job Description

What You Will Do at ODM:

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN 20047592)

Job Overview:

The Registered Nurse (RN) in this position will:

Utilize the Ohio Administrative Code (OAC), and Federal rules, policies, and procedures to make clinical/medical based definitive decisions to determine disability

Review and evaluate medical records and statistical reports

Frequently use electronic medical documentation and software applications, interact with providers, other agencies and external stakeholders

Why Work for the State of Ohio

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.

Qualifications

Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing.

-Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.

-Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.

-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Job Skills: Health Administration

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.

The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.

ADA Statement

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.

Drug-Free Workplace

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.