Medical Frailty Nurse Analyst

State of Indiana•Indianapolis, IN

6d•Onsite

About The Position

Work for Indiana Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana. About the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 18 percent of the state's budget to ensure vital health care coverage to approximately 1 in 4 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. Role Overview: The Medical Frailty Nurse Analyst supports the Office of Medicaid Policy and Planning (OMPP) in the administration, review, and oversight of Indiana Medicaid’s Medical Frailty determinations. This role is responsible for conducting clinical reviews of medically frail determinations, analyzing documentation submitted by Managed Care Organizations (MCOs) and providers, auditing compliance with federal and state requirements, and supporting the accurate identification of members who qualify for medically frail protections. The Medical Frailty Nurse Analyst applies clinical expertise and nursing judgment to evaluate medical, behavioral health, and functional information to ensure medically frail determinations are evidence-based, individualized, and consistent with federal Medicaid requirements. You will serve as a clinical resource to OMPP and state partners and supports quality assurance activities, program monitoring, reporting, and continuous improvement efforts related to medically frail identification and oversight. The ideal candidate is a Registered Nurse (RN) with experience in Medicaid, managed care, clinical assessment, disability determination, utilization management, or care management. Strong analytical skills, clinical judgment, and familiarity with federal medically frail criteria are essential.

Requirements

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.
Individuals should have the ability to perform essential functions with or without reasonable accommodation.

Nice To Haves

Registered Nurse (RN) with experience in Medicaid, managed care, clinical assessment, disability determination, utilization management, or care management.
Strong analytical skills, clinical judgment, and familiarity with federal medically frail criteria are essential.
A degree is not required. However, at least 10 + years of experience applying the outlined knowledge, skills, and abilities in a similar role may be considered. Completion of relevant education degree(s) may substitute for equivalent years of experience.

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.
This position is exempt from overtime compensation for additional work hours which may be required to complete essential functions or other assigned work. Exempt employees may work more than 75 hours in a pay period without additional compensation and must report a minimum of 75 hours per pay period of work hours and/or paid leave taken to receive their base biweekly salary.

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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