What are the responsibilities and job description for the Medical Frailty Program Manager (RN) – Medicaid position at Infosoft Inc.?
We are seeking an experienced Registered Nurse (RN) to join the Office of Medicaid Policy and Planning (OMPP) as a Manager of Medical Frailty. This role provides statewide clinical oversight of the medically frail identification and verification process for Medicaid beneficiaries.
The ideal candidate will have experience in Medicaid, Managed Care, Clinical Assessment, Utilization Management, Disability Determination, or Care Management, along with strong clinical judgment and analytical skills.
Key Responsibilities
- Oversee statewide medical frailty identification and verification processes.
- Review and validate MCO medically frail determinations for accuracy and compliance.
- Conduct clinical reviews, retrospective audits, and complex case determinations.
- Manage and interpret the MARA (Milliman Advanced Risk Adjusters) tool.
- Collaborate with DFR, Gainwell, MCOs, analytics, actuarial, and clinical teams.
- Ensure medically frail determinations are evidence-based and clinically justified.
- Interpret and apply federal and state Medicaid regulations and medically frail criteria.
- Analyze trends and develop reports/dashboards to support program oversight.
- Identify compliance gaps and support corrective action initiatives.
- Provide clinical guidance on documentation standards and case resolution.
Requirements
- Active RN License – Indiana or Compact State.
- Bachelor’s Degree in Nursing (BSN) – Required.
- Strong knowledge of Medicaid programs, eligibility pathways, and medically frail criteria.
- Experience in clinical assessment, utilization review, care management, or disability determination.
- Ability to interpret and apply complex federal and state regulations.
- Strong clinical judgment, analytical, communication, and decision-making skills.
Why Consider This Opportunity?
- Statewide clinical leadership and oversight role
- Opportunity to work across Medicaid, MCO, clinical, IT, and policy teams
- Strategic role involving clinical review, compliance, analytics, and program improvement
Pay: $42.00 - $45.00 per hour
Expected hours: 40.0 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Referral program
- Retirement plan
- Vision insurance
Experience:
- Medical management: 3 years (Required)
- MARA (Milliman Advanced Risk Adjusters) tool: 3 years (Required)
- Managed Care Organizations (MCOs): 3 years (Required)
License/Certification:
- RN License (Required)
Work Location: On the road
Salary : $42 - $45