MCO Contract Control Audit Program Manager - (TMS) - 20068987

BWC’s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC’s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.

This position is being reposted to expand the candidate pool. Candidates need to reapply to be considered.

What You’ll Be Doing:
The MCO Contract Compliance & Strategic Initiatives Lead plays a critical role in ensuring Managed Care Organizations (MCOs) meet all contractual, regulatory, and operational requirements. Under the direction of the Director of MCO Business Reporting, this position leads the development and oversight of contract controls, compliance monitoring, and strategic initiatives that support the integrity and performance of Ohio’s MCO program.

Contract Compliance & Oversight

• Lead the monitoring and enforcement of MCO contract controls (e.g., Business Continuity Plans, cyber insurance, SOC1/SOC2 compliance).

• Develop and implement policies and operational controls to ensure MCOs comply with contract terms and Ohio regulations.

• Track and report MCO compliance status, timelines, and violations to the Director and Medical Services Chief.

Collaborate with the Compliance Performance and Monitoring (CPM) unit to address audit findings and ensure timely MCO responses.

Identify and document contract violations, providing evidence-based reports to leadership and legal teams.

Strategic Projects & Policy Development

• Initiate and manage strategic projects (e.g., SOC2 training, AI-based continuity evaluations, compliance tracking tools).

Support the Director and Medical Services Chief in identifying and executing strategic initiatives.

Develop project plans, metrics, and presentation materials for internal governance and external stakeholders.

Represent the Medical Services Division in cross-divisional and external collaborations.

Write, implement and train on policy and procedures supporting and clarifying contract control requirements.

Training, Communication & Representation

• Design and deliver internal and external training on MCO contract control programs.

• Serve as a representative on MCO Business Council subcommittees and workgroups.

Act as a spokesperson for the Director and Division leadership at meetings and events.

Assist in developing communication strategies for internal staff, stakeholders, and providers.

Administrative & Operational Support

Provide guidance on division operations and staffing plans. Conduct staff meetings and review incoming proposals with recommendations to leadership.

Serve as backup for managing MCO Business Unit communications and mailboxes.

The ideal candidate will be familiar with use of Microsoft Excel. The candidate should also possess an ability to work both independently and to facilitate project teams and demonstrate a high level of critical thinking and analytical skills.

Qualifications

To Qualify, You Must Clearly Demonstrate:

Required Experience and/or Education:
Completion of graduate core program in health care administration AND 12 months experience in medical policy development for medical provider or insurance company.


Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study AND 12 months practical experience in health care field AND 12 months experience in writing medical policies & procedures for medical provider or insurance company.


Or certified medical coder in current procedural terminology (CPT) hospital coding, or current ICD coding system AND 12 months experience in writing medical policies & procedures for medical provider or insurance company AND 12 months practical experience in health care field.

*** THE 12 MONTHS EXPERIENCE WRITING MEDICAL POLICIES & PROCEDURES IS REQUIRED FOR EACH SECTION FOR THE ABOVE MINIMUM QUALIFCATIONS. YOU MUST HAVE THIS IN ADDITION TO THE OTHER MINIMUM QUALIFICATIONS IN THE SECTION ***

MAJOR WORKER CHARACTERISTICS:

Knowledge of medical/rehabilitation services; health care coverage & reimbursement techniques; health care
administration; cost containment measures; statistical analysis; workers' compensation medical policies & insurance
industry standards*; supervisory principles/techniques*. Skill in operation of personal computer*. Ability to understand
somewhat abstract field of study (i.e., health care); write & edit technical manuals & instructions; create complex reports
using computer software; gather, collate & classify information about data, people or things.
(*)Developed after employment.

Supplemental Information

EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to a disability, pregnancy, or religion please contact the ADA mailbox [email protected]

Salary Information:
Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.

Transportation:
Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts:
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.

Background Check:
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.