Clinical Quality Specialist

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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.

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, Path Ways 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.

The ideal candidate in this role should minimally have either: a Registered Nurse (RN) License plus three (3) years of experience, or a Licensed Practical Nurse (LPN) License plus five (5) years of experience, or an Associates Degree in a clinical discipline plus seven (7) years of experience, or 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.

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

The salary for this position traditionally starts at $67,314.00 but may be commensurate with education or work experience. Use our
Compensation Calculator to view the total compensation package.

The essential functions of this role are as follows:

• 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…