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: Health Innovation & Quality

Bureau: Clinical Operations

Working Title: Medicaid Health Systems Specialist (RN) (PN:20043101) 

Job Overview:

This position is headquartered in Franklin County. As the Compliance & Safety Check Nurse/Reviewer in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Conducting compliance and safety check surveys, many of which occur in the consumer's home


• Conducting oversight activity to include medical & programmatic document review & face to face (e.g., may be conducted on-site) assessments &/or reassessment (e.g., questionnaires & documents to review programs) & all oversight activity of all Medicaid programs (e.g., PACE, PASSARR, Waiver) administered by other state agencies (e.g., Ohio Department of Education (ODE), Ohio Department of Health (ODH), Mental Health and Addiction Services (OMHAS), Ohio Department of Youth Services (ODYS), Ohio Department of Aging (ODA), Ohio Department of Developmental Disabilities (DODD)) & ODM Ohio Home Care/State Plan, Managed Care


• Reviewing & evaluating medical & programmatic documents developed by contractors, county boards & providers to determine quality assurance of health & safety & clinical &/or programmatic appropriateness of services &/or payment policies.

As the Compliance and Safety Check Nurse/Reviewer, you will be required to possess a current and valid license to practice professional Nursing as a Registered Nurse (RN) in Ohio as issued by the Board of Nursing in order to conduct

compliance and safety check surveys of Ohio's Medicaid consumers. Travel throughout Ohio is required, some of which

will include overnight stays.

Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing. 

Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.