MCO Control Audit Program Manager PA

Overview

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.

Position Overview:

The MCO Contract
Control Program Manager 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 the seven contracted managed care organizations (MCOs) working within Ohio’s Health Partnership program (HPP).

• Policy Development,
  Contract Compliance & Oversight
• Formulate and implement program policies to support the MCO Contract Control, Risk and Compliance Management program.
• Lead the monitoring and enforcement of MCO contract controls (e.g., Business Continuity Plans, cyber insurance, AICPA SOC1/SOC2 compliance).
• Develop and implement policies and operational controls to ensure MCOs comply with contract terms and Ohio regulations.
• Develop the compliance strategy to mitigate Agency risks, and track and report MCO compliance status, timelines, and violations to the Director and Medical Services Chief.
• Identify and document contract violations, providing evidence-based reports to leadership and legal teams.

• Initiate and manage strategic projects to support program and policy development and management (e.g., SOC2 training, AI-based continuity evaluations, compliance tracking tools).
• Develop project plans, metrics, and presentation materials for internal governance and external stakeholders.
• Represent the Medical Services Division in cross-divisional and external collaborations.

• Design and deliver internal and external training on MCO contract control programs.
• Serve as a representative on MCO Business Council subcommittees and work groups.
• 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.

To Qualify, You Must Clearly Demonstrate:

Required Experience and/or

Education:

5 yrs. trg. or 5 yrs. exp. in business administration, management or public administration.

-Or completion of undergraduate core program in business administration, management or public administration; 36 mos. trg. or 36 mos. exp. in supervisory, administrative &/or managerial position.

-Or completion of undergraduate core program for academic field of study commensurate with program area to be assigned per approved Position Description on File; 36 mos. trg. or 36 mos. exp. in supervisory, administrative, managerial &/or staff position involving planning, research &/or policy/procedure development.

-Or 1 yr. exp. as Program Administrator 2, 63123.

-Or equivalent of Minimum Class Qualifications For Employment noted above.

Prefer graduate level candidate, including master’s degree in business administration, management, health or public administration, or law degree; or a bachelor’s degree in accounting or related field with contract management, audit or compliance experience.

Job

Skills:

Program Management

Knowledge of business administration, management science or public administration; supervisory principles/techniques; public relations; employee training & development; budgeting.
Ability to define problems, collect data, establish facts & draw valid conclusions; develop complex reports & position papers; handle sensitive face-to-face contacts with public & government officials; establish friendly atmosphere as supervisor of work unit.