Medicaid Quality Control Analyst (Case Management Analyst) (260007CN)
: Medicaid
Agency Contact Name and Information: HumanResources@medicaid.ohio.gov
: Oct 15, 2026, 3:59:00 AM
Lazarus 4
50 West Town Street
Columbus 43215
: United States of America-OHIO-Franklin County-Columbus
Compensation: $$31.47/hour
: Full-time
Work Hours: 8:00 am - 5:00 pm
Classified Indicator: Classified
Union: OCSEA
: Health Administration
Technical Skills: Health Administration
Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication
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.
What You Will Do At ODM:Office: Legal CounselBureau: Program IntegrityClassification: 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.Why Work for the State of OhioAt 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.
Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.
-Or 36 mos. exp. as public assistance caseworker, with experience in all categories of public assistance; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver’s license.
-Or equivalent of Minimum Class Qualifications for Employment noted above.
Technical Skills: Health Administration Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written CommunicationSupplemental InformationSupplemental 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.ADA StatementOhio 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 WorkplaceThe 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.
Employment with the State of Ohio is more than ‘just a job’ – it is a privilege to serve our families, friends and neighbors who rely on us throughout our great state. We are a team of dedicated public servants committed to high performance, innovative thinking, and delivering excellent and efficient services. Our goal is to recruit and retain the best talent for our positions, because when we have the best talent, we get the best results for our community. We are #TeamOhio.
