Manager of Medical Frailty

State of Indiana; Indianapolis (IN); On-site; USD 68,000 - 83,000; Full time

Benefits offered by this job

Medical plan options (3)

Vision & Dental plans

Wellness program

Employer HSA contribution

Two pension plan options

Paid leave & holidays

Education reimbursement

LinkedIn Learning access

Free parking

Job summary

State of Indiana is seeking a Manager of Medical Frailty to oversee the medically frail determination process for the OMPP. This role coordinates clinical reviews, audits, and verification across Medicaid, managed care, and policy teams.

The ideal candidate is an RN with Medicaid experience, strong analytical skills, and knowledge of federal frail criteria. This exempt position may require substantial hours and offers extensive state benefits.

Qualifications

• Registered Nurse with Medicaid/managed care experience is required.
• Strong analytical skills and clinical judgment are essential.
• Familiarity with federal medically frail criteria is preferred.

Responsibilities

• Oversee identification and verification of medically frail beneficiaries.
• Conduct clinical reviews and retrospective audits of qualifications.
• Validate MCO submissions and ensure appropriate benefits pathways.
• Collaborate with clinical teams, IT, and legal departments.
• Ensure compliance with federal and state policies and grants.

Skills

RN

Medicaid experience

Clinical assessment

Utilization management

Analytical skills

Education

Nursing license (RN)

Job description

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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.

About the Family & Social Services Administration (FSSA):

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 Manager of Medical Frailty supports the Office of Medicaid Policy and Planning (OMPP) in overseeing the complex classification of Healthy Indiana Plan beneficiaries who qualify for exemptions from Medicaid community engagement requirements. This role bridges clinical teams, IT systems, and legal departments to verify medical frailty using claims data, provider certifications, and health screener. Your role provide statewide clinical oversight of the medically frail identification and verification process. You will ensure that medically frail determinations are individualized, evidence-based, and clinically justified, rather than automatically assigned based on diagnosis alone. The Manager of Medical Frailty will conduct clinical reviews, perform retrospective audits, validate MCO submissions, and ensure that members who qualify for medically frail protections receive appropriate benefits and coverage pathways.

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.

The salary for this position traditionally starts at$75,010.00 but may be commensurate with education and work experience. Use our Compensation Calculator to view the total compensation package.

A Day in the Life:

The essential functions of this role are as follows:

• Plan, organize, direct, monitor, and participate in ongoing comprehensive development and implementation of specialized programs and development within the agency.
• Determine, analyze, identify 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 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.

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.

What You'll Need for Success:

Individuals in this role should minimally be able to articulate or demonstrate the following:

• Extensive knowledge of the principles, practices, and techniques of a broad area of training and education, including texts and materials developed in the field.
• Thorough knowledge of the agency or institution’s functions, operations, and purpose.
• Considerable knowledge of experiential learning techniques.
• Practical knowledge of laws, rules, and regulations governing mandated training within the agency.
• Ability to develop, monitor and evaluate broad training programs.
• Ability to plan and conduct seminars, workshops, and training sessions.
• Ability to assemble training materials, including writing comprehensive manuals and assembling texts, films, slides, and characters.
• Ability to establish effective and cooperative working relationships with trainees, other instructors, and the entire agency staff.
• Ability to keep current on new trends, philosophies, and available materials regarding adult education.
• Ability to delegate work, set clear direction, and manage workflow.
• Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skill sets.

A degree is not required. However, at least 12 + 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.

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

Supervisory Responsibilities/Direct Reports:

This role may provide direct supervision for one or more staff members.

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 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 to401(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
• Employee assistance program that allows for covered behavioral health visits
• Qualified employer for the Public Service Loan Forgiveness Program
• Free Parkingfor most positions
• Free LinkedIn Learningaccess

The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role. If you require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at [e-mail] .