Clinical Quality Specialist

State of Indiana•Indianapolis, IN

16h•Onsite

About The Position

The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 13 percent of the state's budget to ensure vital health care coverage to approximately 1 in 5 Hoosiers. OMPP strives to build programs and processes that enable Hoosiers to live in fully engaged communities and reach their greatest emotional, mental and physical well-being. Our mission is to support individual and community well-being with effective and efficient programs, remarkable collaborations, measurable impact on individuals and communities, and an energized staff that is fully engaged with this mission. The Clinical Quality Specialist supports the Office of Medicaid Policy and Planning (OMPP) by overseeing quality assurance, regulatory compliance, and performance improvement across all Indiana Medicaid programs which include Hoosier Healthwise, Healthy Indiana Plan (HIP), Hoosier Care Connect, PathWays for Aging, and Fee-for-Service Medicaid. You will ensure that quality strategies are data-driven, equitable, and aligned with federal and state standards to improve health outcomes for all Hoosiers. You will be responsible for quality oversight of vendors and partners working in the clinical space of Indiana Medicaid, including Managed Care Entities (MCEs) and Fee for Service vendors. You will be responsible for aligning efforts in conjunction with state laws and rules as well as federal requirements. The role entails considerable amounts of public-speaking, problem-solving, research, negotiation, collaboration, and some in-state travel.

Requirements

Registered Nurse (RN) License plus three (3) years of experience
Licensed Practical Nurse (LPN) License plus five (5) years of experience
Associates Degree in a clinical discipline plus seven (7) years of experience
At least ten (10) years of experience in a clinical setting applying the knowledge, skills, and abilities as listed in the ‘What You’ll Need for Success’ section of the Job Profile.
Mastery knowledge in program subject matter obtained through experience and/or education.
Broad knowledge of provider agencies and their programs and services.
Broad knowledge of all source materials and references including federal and state laws governing the programs.
Ability to adapt new statues and guidelines to create and implement new principles and policies and discern any far-reaching implications.
Ability to present and represent the agency to both internal and external customers, the public, government officials, and other stakeholders.
Analyzing information and evaluating results to choose the best solution and solve problems.
Ability to work effectively with a wide variety of stakeholders.
Ability to analyze and prepare monthly finance and accounting reports to maintain program budget and grants.
Ability to delegate work, set clear direction, and manage workflow.
Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skillsets.
Able to perform essential functions with or without reasonable accommodation.

Nice To Haves

Experience with qualitative and quantitative analysis tools
Experience with CMS quality measures
Experience with NCQA standards
Experience in healthcare quality
Experience in contract oversight
Experience in audit processes
Experience in Medicaid policy
Experience in public health analytics
Clinical experience in managed care

Responsibilities

Establish, monitor, and implement long-range objectives and specifying the strategies, KPIs, and actions to achieve them.
Analyze operations to evaluate performance of the specific program or its staff in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change.
Interpret and explain in-depth and complex policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals.
Develop and implement corrective action plans to solve organizational or departmental problems.
Prepare and present reports for approval, including those for funding or implementation of services to executive leadership.
Develop and oversee program financial or budget activities to fund operations, maximize investments, or increase efficiency.
Develop and monitor program requirements to ensure it meets federal and state policies and grants compliance.
Develop and supervise training of employees and consultants on program requirements and usage.
Develop, coordinator, and deliver communication plans and communications.
Preside over, or serve on, boards of directors, management committees, or other governing boards.
Recruit, select, onboard, and train employees to ensure role responsibilities and expectations are clearly understood while providing opportunities to continue professional development.
Set expectations, measure progress, provide ongoing feedback, and evaluate the performance of employees.
Ensure work adheres to quality standards, deadlines, and proper procedures.

Benefits

Three (3) medical plan options (including RX coverage) as well as vision and dental plans
Wellness Rewards Program: Complete wellness activities to earn gift card rewards
Health savings account, which includes bi-weekly state contribution
Deferred compensation 457(b) account (similar to 401(k) plan) with employer match
Two (2) fully-funded pension plan options
A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to: 150 hours of paid New Parent Leave and up to eight weeks of paid Childbirth Recovery Leave for eligible mothers
Up to 15 hours of paid community service leave
Combined 180 hours of paid vacation, personal, and sick leave time off
12 paid holidays, 14 on election years
Education Reimbursement Program
Group life insurance
Referral Bonus program
Employee assistance program that allows for covered behavioral health visits
Qualified employer for the Public Service Loan Forgiveness Program
Free Parking for most positions
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