This role supports the grant-supported Pregnancy Promise Program, which aims to help pregnant individuals with substance use disorder (SUD) achieve sustained recovery and reduce neonatal abstinence syndrome in their offspring. The specialist works closely with the Project Manager, FSSA Chief Medical Officer, and internal and external stakeholders, engaging Medicaid members, families, providers, and advocates at all stages. This high-profile State initiative addresses attacking the drug epidemic and lowering infant mortality.
Responsibilities
Help develop and revise project materials and outreach for referring agencies, including health care systems, human service agencies, and community-based organizations
Monitor, review, and analyze performance outcomes and data quality for each of the four Managed Care Entities (MCEs), and review biweekly MCE updates to ensure required CMS measures are met
Ensure accurate data reaches OMPP so enrollment is reflected in CoreMMIS; work with OMPP on a CoreMMIS enrollment “check box” and on answering eligibility questions for potential enrollees
Develop and revise MCE Complex Case Manager training materials
Monitor and analyze performance and quality outcomes data for each MCE's complex case management program; assist and give feedback to MCE project managers
Help develop and deliver stakeholder presentations, traveling statewide to present to all provider types, at conferences, and at other events
Help write quarterly and annual CMS reports; with the Project Manager, track grant activities to meet report and budget timelines and assist with CMS documentation requests during the grant period
Help develop a new statewide MCE Complex Case Manager Best Practices Forum, collect quality improvement data, and facilitate implementation of new standard procedures
Research, draft, and disseminate complex case management best practice guidelines; draft a program manual, updated at least annually, covering guidelines, data requirements, case management practices, etc.
Ensure grant funds are allocated per federal, state, and grant guidelines and financial reports are submitted on time per federal requirements
Address implementation barriers through field visits with MCE and community provider case managers, with problem-solving and feedback loops
Develop agendas and coordinate cross-sector participants for regional meetings and MOM grant listening tours in the State's five Medicaid regions
Serve as liaison to enrollees, community mental health center staff, referral sources, and project partners; answer emails, calls, and texts from enrollees, MCE care coordinators, and other providers within 2 business days, providing program guidance
Help develop the public-facing website of resources for members, loved ones, and providers; review it for updates and work with the communications team on changes
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Tailored applications submitted
Manage website referrals: confirm Medicaid coverage/eligibility and route to the correct MCE
Obtain and maintain Indiana Navigator licensure (8 hours of training, provider quiz, IDOI exam)
Complete Medicaid applications for potential enrollees without coverage, with continuous outreach through 90 days postpartum
Make all program materials as equitable and inclusive as possible; collaborate with Indiana 211 for members who are not eligible for the program
Resolve disputes between MCE and community case managers; support and assist managed care case managers on individual client issues and best practices
Coordinate with the Project ECHO Coordinator on curriculum, presenters, and scheduling for case managers and community health workers serving the target population
Work with the data and analytics team on developing an FSSA data app
Record thorough, accurate minutes at all meetings for FSSA colleagues, MCEs, and stakeholders
Resolve issues with professionalism and sensitivity and work well with other agencies and divisions
Use standard word processing, spreadsheet, and database programs; compile, synthesize, and present complex recommendations
Requirements
Bachelor's Degree in social work, public health, public administration, or similar (consider 4-5 years experience in lieu of degree)
Prior experience with Medicaid or Medicare care coordination and case management
Extensive understanding of Medicaid, waiver services, and managed care, plus state laws, policies, and procedures for Medicaid programs
Knowledge of state and federal laws, regulations, and policies on addiction treatment
Experience managing federal or state grants, including budget oversight
Experience working with a wide range of stakeholders, including people with lived experience, families, advocates, and mental health or addiction providers
Experience with planning, program development, and program evaluation
Experience working with standard word processing, spreadsheet, and database programs
Nice to have:
Indiana Navigator License
Important Details
Duration: 12+ months, anticipated to last through 9/30/2027 with the possibility to extend longer
Work format: hybrid with field travel, 2 days in office, 3 days remote/travel
Schedule: 37.5 hours per week
Travel: approximately 40-50% local travel with occasional overnight travel required, expenses reimbursed for field travel
Team: works closely with the Project Manager, FSSA Chief Medical Officer, and internal and external stakeholders
About the Company
The Family and Social Services Administration (FSSA) compassionately serves Hoosiers of all ages and connects them with social services, health care, and their communities. The agency includes the Office of Medicaid Policy and Planning (OMPP), a division that receives around 13 percent of the state's budget to provide vital healthcare coverage to roughly 1 in 5 Hoosiers.
