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Clinical Policy Manager

Date Posted:  Nov 21, 2022
Requisition ID:  397181
Location: 

Indianapolis, IN, US, 46204

 

Work for Indiana

Grow your career with the State of Indiana! With more than 50 executive branch agencies, the State of Indiana is a diverse workforce offering employees stimulating and challenging projects across a broad scope of career opportunities. As a State of Indiana employee, you impact the well-being of Indiana’s communities every day.

 

At the State of Indiana, we don’t just talk about diversity and inclusion – Our goal is to create a welcoming, accessible, and equitable workplace, with a workforce that is representative of the State of Indiana population. As a proud equal opportunity employer, reasonable accommodations may be available to enable individuals with disabilities to interview and to perform the essential functions of a role.

 

Next Level benefits at the State of Indiana are here! Be sure to review our expanded benefit package offerings below.

 

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 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. 

 

Salary: This position traditionally starts at an annual salary of $67,314.00.  Salary for this position may be commensurate with education and job experience.


Role Overview:  The Clinical Policy Manager will draft, review, and publish clinical policies in coordination with internal and external stakeholders including clinical, policy, government affairs, provider services, member services and reimbursement staff as well as the provider community.  You will be responsible for 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. 

Candidates must have a current, unrestricted RN license from the State of Indiana.  The ideal candidate will have a bachelor’s degree in nursing, public administration, public policy, public health, or related program that provides the skills needed to conduct oversight of all utilization management practices and clinical criteria evaluations, plus a minimum of three years of experience in healthcare policy research or practice.  Clinical experience in managed care strongly preferred.

About the Job:

As the State Program Director, you will be responsible for administering a program within a state agency and serve as the specialist in a specific area. In this position, you will utilize education, consultation, cooperative programming, and coordination to accomplish goals. 

A Day in the Life:

​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. 
  • 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 designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice. 

What You'll Need for Success:

You must meet the following requirements to be considered for employment: 

  • 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. 

Supervisory Responsibilities/Direct Reports:

This role may serve as a team lead for an assigned work group.

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes: 

  • Three (3) medical plan options (including RX coverage) as well as vision and dental plans
  • Wellness program (offers premium discount for the medical plan and gift cards)
  • Health savings account, which includes bi-weekly state contribution
  • Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities
  • Deferred compensation 457B account (similar to 401k 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
    • 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
  • Free LinkedIn Learning access

     

Equal Employment Opportunity:

The State of Indiana is an Equal Opportunity Employer.

 

Current Employee? Click here to apply.


Nearest Major Market: Indianapolis