Join to apply for the Utilization Management Manager role at Indiana Family and Social Services Administration.
Role Overview
The role of Utilization Management Manager oversees the integration of utilization review, clinically appropriate care, and risk management to ensure quality assurance in Indiana Medicaid. In this position you will serve as the utilization management subject‑matter expert, develop reporting requirements for all Medicaid programs, analyze data to determine impact on members, providers, and Managed Care Entities, and build partnerships to maintain high standards of quality across Medicaid programs. This role provides direct supervision for one or more staff members and requires travel.
Key Responsibilities
Plan, organize, direct, monitor, and participate in ongoing development and implementation of specialized programs and initiatives within the agency.
Determine, analyze, and implement long‑range objectives, specifying strategies, KPIs, and actions to achieve them.
Analyze operations to evaluate program or staff performance, identifying areas for cost reduction, improvement, or policy change.
Interpret and explain complex policies, rules, regulations, or laws to agencies, 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 funding or implementation of services to executive leadership.
Develop and oversee program financial or budget activities to fund operations and maximize efficiency.
Develop and monitor program requirements to ensure federal and state policy and grant compliance.
Develop and supervise training of employees and consultants on program requirements and usage.
Coordinate 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, ensuring clarity of role responsibilities and opportunities for development.
Set expectations, measure progress, provide ongoing feedback, and evaluate employee performance, ensuring work adheres to quality standards and deadlines.
Required Qualifications
Associate’s, Bachelor’s, or Master’s degree in nursing, public administration, public policy, public health, or related program.
Current unrestricted RN license from the State of Indiana.
Minimum of three (3) years of experience in healthcare and utilization management.
Minimum of three (3) years of staff management and evaluation experience.
Clinical experience in managed care and accredited utilization management strongly preferred.
Strong data and information‑technology skillset for collecting and analyzing data.
Additional Experience and Knowledge
Extensive knowledge of training and education practices, including text and material development.
Thorough knowledge of agency functions, operations, and purpose.
Experience with experiential learning techniques and adult education.
Understanding of laws, rules, and regulations governing mandated training within the agency.
Ability to develop, monitor, and evaluate broad training programs; conduct seminars, workshops, and training sessions.
Proficient in assembling training materials (manuals, slides, etc.).
Effective in establishing working relationships with trainees, instructors, and agency staff.
Staying current on new trends and materials in adult education.
Ability to delegate, set direction, manage workflow, provide feedback, and coach employee skill sets.
Capability to perform essential functions with or without reasonable accommodation.
Supervisory Responsibilities
This role may provide direct supervision for one or more staff members.
Benefits of Employment with the State of Indiana
Three (3) medical plan options (including RX coverage) and vision, dental plans.
Wellness Rewards Program with gift card rewards.
Health savings account with bi‑weekly state contribution.
Deferred compensation 457(b) account with employer match.
Two (2) fully‑funded pension plan options.
Paid leave policies including 150 hours new parent leave, 8 weeks childbirth recovery leave, 15 hours community service leave, and combined 180 hours vacation, personal, and sick leave.
12 paid holidays and 14 on election years.
Education reimbursement program.
Group life insurance.
Employee assistance program with covered behavioral health visits.
Qualified employer for Public Service Loan Forgiveness Program.
Free parking and LinkedIn Learning access.
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 this role. If you require reasonable accommodations, please contact the Indiana State Personnel Department at jobs@spd.IN.gov .