Clinical Quality Specialist

Clinical Quality Specialist

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 and Social Services Administration:
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.

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. This includes 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 will have a bachelor's degree in nursing, public health, health administration, data analytics, or related program that provides the skills needed to provide quality program oversight and expertise. 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.

Salary Statement:
The salary for this position traditionally starts at $67,314.00 but may be commensurate with education or work experience.

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 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.

The job profile is not…