Travel Nurse RN - Manager
Indianapolis, IN
TalentBurst, Inc
5x8 hrs

Short Description:
Nurse Manager of Medical Frailty

Complete Description:
Purpose of Position/Summary:


The Office of Medicaid Policy and Planning
(OMPP) is a division within the Family and Social Services Administration
(FSSA), 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 Manager of Medical Frailty supports OMPP in
overseeing
the complex classification of Healthy Indiana Plan beneficiaries who qualify
for exemptions from Medicaid community engagement requirements. This position
bridges clinical teams, IT systems, and legal departments to verify medical
frailty using claims data, provider certifications, and health screener. The
position provides statewide clinical oversight of the
medically frail identification and verification process, including review of
Managed Care Organization (MCO) determinations, management of the MARA
(Milliman Advanced Risk Adjusters) tool, and coordination with the Division of
Family Resources (DFR), Gainwell, and other partners to ensure compliance with
federal and state requirements.


This roe ensures 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.


Essential Duties/Responsibilities:



- Statewide
Medical Frailty Oversight


- Oversee the medical frail identification and
verification process across all Indiana Medicaid programs.

- Review and validate MCO medically frail
determinations for accuracy, completeness, and compliance.

- Ensure determinations reflect clinical judgment, not
automatic assignment based solely on diagnosis (e.g. HIV, SUD, chronic
conditions).

- Provide final clinical determinations for complex or
borderline cases.


- MARA
Tool Management


- Serve as the program lead for the MARA
risk-adjustment tool as it relates to medically frail identification.

- Interpret MARA outputs and integrate them into the
medically frail review workflow.

- Collaborate with actuarial and analytics teams to
refine MARA parameters and ensure alignment with policy intent.


- Cross-Agency
Coordination


- Work closely with DFR to ensure accurate eligibility
pathways for medically frail members.

- Coordinate with Gainwell on systems configuration,
data accuracy, and backend processing.

- Provide clinical consultation to internal teams
regarding medically frail criteria, documentation standards, and case
resolution.


- Audit
& Compliance


- Conduct retrospective audits of MCO determinations to
ensure compliance with federal and state medically frail requirements.

- Identify patterns of over- and under-designation and
implement corrective action plans.

- Ensure the state
remains aligned with federal Centers for Medicare & Medicaid Services
(CMS) guidelines regarding the significantly impairs standard and
12-month look-back periods.


- Clinical
Review & Determination


- Perform clinical assessments of member documentation
to determine whether functional or behavioral health needs meet medically
frail criteria.

- Apply federal definitions, including serious and
complex medical conditions, functional impairments, and chronic substance
use disorders.

- Document clinical rational or determinations and
communicate decisions to MCOs and internal partners.


- Data
Analysis & Reporting


- Analyze medically frail trends, disparities, and
program impacts.

- Collaborate with FSSA Data & Analytics to develop
dashboards and reports to support oversight and policy decisions.

- Monitor MCO performance and identify opportunities
for improvement.


- Other
Duties as Assigned



Job Requirements:


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



Registered Nurse (RN)
license required (Indiana or compact state)-active and in good standing.



Bachelor s degree in
nursing required.



Strong knowledge of
Medicaid programs, eligibility pathways, and medically frail criteria.



Experience with
clinical assessment, disability determination, care management, or utilization
review.



Ability to interpret
federal and state reuglations and apply them to complex clinical scenarios.


Supervisory Responsibilities/Direct Reports:


This role may supervise staff supporting
medically frail operations, audits, or clinical review functions.


Difficulty of Work:


Work requires advanced clinical judgment,
interpretation of complex regulations, and the ability to apply nuanced
criteria to individual cases. Work is both strategic and detail-oriented,
requiring autonomy, accuracy, and sound decision-making.


Personal Work Relationships:


Must work effectively with OMPP leadership,
DFR, Gainwell, MCOs, actuarial teams, analytics teams, and external partners.
Must be able to represent OMPP s clinical and policy positions professionally
and accurately.


Physical Effort:


No unusual physical effort is required. May be required to carry or lift up to 10
lbs. occasionally. Will be required to
type/use a computer for extended periods of time. Some meetings are day-long and require
continuous attendance offsite.


Working Conditions:


Standard office environment when present in
office. Occasional travel may be
required with some overnight stays possible, dependent on season/time of year. The nature of this position may occasionally require
commitments of time in excess of the standard workday.

Skills:
SkillRequired / DesiredAmountof ExperienceExpertise RatingMoveIndiana Licensed/or Compact State Licensed RN or NP with current unencumbered license.RequiredBachelor's degree in nursing.RequiredStrong knowledge of Medicaid programs, eligibility pathways and medically frail criteria.Required3YearsExperience with cflinical assessment, disability determination, care management or utilization review.Required3YearsAbility to interpret federal and state regulations and apply them to complex clinical scenariosRequired3YearsPrior experience utilizing data analysis and analytics, interpreting regulations.Required3YearsAbility to work autonomously with strong judgment and decision making skills.RequiredPrior experience with complex physical or behavioral conditions.Highly desiredPrior experience in a management role, preferably UM or case management team.Highly desired

Questions:
Question 1
Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you agree to this requirement?
Question 2
What is your candidate's email address?
Question 3
Where does your candidate currently reside (City & State)?
Question 4
If selected for engagement, your candidate s hourly Pay Rate must be ***/hour. The Provider Markup for this position is 35%. Do you agree to these requirements?
Question 5
Position is on-site Monday thru Friday, 7.5H days, 37.5H week. Does candidate accept this requirement?
Question 6
No time off can be accommodated during the first several months, through the end of February 2027, (aside from State Holidays). Does candidate accept this requirement?
Question 7
Position is for initial 6 months with possibility for state hire at the end of the 6-month period, based on performance. Does candidate accept this requirement?

Agency Interview Type:
Phone and in-person

Work Arrangement:
Onsite

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