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Full-time
bachelor degree, postgraduate degree
Paid Time Off, Medical Insurance, Dental Insurance, Vision Insurance, Retirement Planning, Employer Contribution
Posted 22d ago
~40 hrs/week
Responsibilities
Oversee Medicaid grievances, appeals, and State Fair Hearing activities to ensure compliance with 42 CFR Part 438. Represent the organization during hearings and provide guidance to staff on adverse benefit determinations.
Requirements
Requires a Bachelor's degree in health administration, social work, or a related field and experience managing Medicaid appeals. A Master's degree or advanced professional credential is preferred.
Full job description
Why Join Unison Health?
Unison Health provides a mission-driven work environment focused on staff support, professional growth, and work-life balance. We are committed to helping our employees thrive while making a lasting difference in the lives of children and families. For over 50 years, Unison Health has proudly supported individuals, families, and communities across Ohio. From behavioral health and substance abuse treatment to primary healthcare, we are dedicated to our mission: Making Lives Better.
Compensation & Benefits:
Paid Time Off (PTO) Starting at 16 Days/Year
Medical with federal minimum deductibles
Dental and Vision coverage
Retirement planning and employer contribution
Apply to Hear More!
Position Summary:
Medicaid Appeals, Grievance & Fair Hearing Officer is a senior administrative and compliance role responsible for overseeing Medicaid grievances, appeals, and State Fair Hearing activities in compliance with 42 CFR Part 438. This position serves as the organization’s primary subject matter expert on adverse benefit determinations, authorization denials, continuation of benefits, and Ohio Medicaid State Fair Hearing preparation and representation.
Key Responsibilities & Role Highlights:
Oversee and manage Medicaid grievances and appeals related to service denials, reductions, suspensions, terminations, and failure-to-act cases in accordance with regulatory requirements.
Ensure Notices of Action are issued and reviewed for compliance, including required timelines, content, appeal rights, and continuation of benefits provisions.
Coordinate with clinical, utilization management, billing, and provider teams to gather documentation and support appeal determinations.
Lead the preparation and coordination of Ohio Medicaid State Fair Hearings, including appeal summaries, hearing packets, and supporting documentation.
Represent or support the organization during hearings before the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings.
Provide guidance and training to providers and staff regarding Medicaid appeals, grievances, hearing rights, and regulatory requirements.
Monitor, identify, and escalate compliance concerns, including potential issues related to denials, recoupments, and adverse benefit determinations.
Analyze grievance and appeal trends, prepare reports for leadership, and recommend quality improvement and risk mitigation strategies.
Education & Experience Requirements:
Bachelor’s degree in health administration, Social Work, Public Administration, Legal Studies, or a related field required.
50+ Years of Making Lives Better in Northwest Ohio.
Industry
Mental Health Care
Company size
201-500 employees
Headquarters
Toledo, Ohio
LinkedIn followers
1,742
Unison Health is a nonprofit organization with over 50 years of experience providing compassionate, comprehensive behavioral health care and substance use treatment services to individuals of all ages. We are committed to making mental health and addiction services accessible, affordable, and stigma-free for our community.
As a trusted leader in Northwest Ohio, Unison Health is accredited by The Joint Commission and certified by the Ohio Department of Mental Health and Addiction Services. We are proudly supported in part by the Mental Health & Recovery Services Board of Lucas County and the Wood County ADAMHS Board.
Our Services Include:
Specialized care for adults with severe and persistent mental illness (SPMI)
Medication management and psychiatric services for adults and youth
Substance use treatment for youth ages 11–17, including assessment, individual therapy, intensive outpatient programming, and aftercare
Home-based family therapy for children with serious emotional challenges
Individual and group outpatient counseling for adults and children
OhioRISE care coordination services for Medicaid-eligible youth with complex behavioral health needs
At Unison Health, we believe in strengthening lives, supporting families, and building healthier communities—one person at a time.
Offices: 1425 Starr Ave, Toledo, Ohio 43605, US · 544 East Woodruff, Toledo, Ohio 43604, US · 1212 Cherry Street, Toledo, Ohio 43608, US
Mental HealthHealth DiagnosticsHealth CareNon ProfitMedicalPrimary and Urgent Care
Based on 738 listings with disclosed salaries, most social services jobs in Ohio pay between $48k–$90k per year. Individual offers vary with seniority, company size, and specialization.
How many Social Services jobs are open in Ohio right now?
There are currently 7,012 open social services positions in Ohio listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Social Services roles in Ohio?
Companies currently hiring include LifeWise Academy, ViaQuest, Inc., Sprenger Health Care Systems, Otterbein SeniorLife, I Am Boundless, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Social Services jobs in Ohio?
Yes — 525 of the 7012 open social services positions offer remote or hybrid work (136 remote, 389 hybrid).
How do I apply for Social Services jobs in Ohio?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.