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5/26/2025 (8:00 PM EDT)

25-03149

Nurse Consultant/Inspector

Salary

$68,324.40 - $76,141.68 Annually

Employment Type

EXECUTIVE BRANCH | FULL TIME | ELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK

Hiring Agency

Cabinet for Health & Family Services | Department for Medicaid Services

Location

275 E Main Street
Frankfort KY 40621 USA

The agency may authorize the selected candidate to telecommute. The agency may terminate or modify the telecommuting arrangement at any time.

Description

The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing programs, services and supports that protect and promote the health and well-being of all Kentuckians and their communities.

The Medicaid Quality Branch located within the Division of Quality and Population Health is looking for a goal-oriented individual who is focused on improving the quality of care our Medicaid Enrollees receive. We are focused on continuous quality improvement in healthcare for our Kentucky Medicaid Enrollees through oversight and collaboration with the Managed Care Organizations contracted here in the Commonwealth. We strive to lead quality initiatives and work closely with an External Quality Review Organization to assist in monitoring the quality performance of the Managed Care Organizations and to ensure that all Federal and State Regulations are followed. The qualified candidate will have the ability to work within a team that is unified in finding positive health outcomes for the Medicaid Enrollees here in the Commonwealth.

Learn more about us at: https://chfs.ky.gov/agencies/dms/Pages/default.aspx

Responsibilities and Duties:

• Provides clinical quality oversight for the Managed Care Organizations contracted with the State.
• Monitors continuous quality improvement for the Managed Care Organizations.
• Works closely with an External Quality Review Organization for adherence to Federal and State guidelines.
• Researches National Committee for Quality Assurance (NCQA) standards and identify guidelines and benchmarks to assist with the review of Healthcare Effectiveness Data and Information Set (HEDIS).
• Reviews contractually mandated reporting for contract compliance and offers suggestions for quality improvement.
• Other duties as assigned.

Preferred Knowledge/Skills/Abilities:

• Background in Healthcare Data Analytics
• Strong background in Healthcare Quality
• Experience with Healthcare Effectiveness Data and Information Set (HEDIS) Quality Performance Measures
• Experience with Federal and State laws and guidelines. Code of Federal Regulations (CFR) 438 Managed Care
• Works well within a team
• Be self-motivated with success as an outcome.
• Experience with Excel

The Cabinet for Health and Family Services (CHFS) participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in U.S. CHFS will only use E-Verify once you have accepted a job offer and completed the Form I-9. For more information on E-Verify, or if you believe that CHFS has violated its E-Verify responsibilities, please contact Department of Homeland Security (DHS) at 888-897-7781 or https://www.e-verify.gov/

Minimum Requirements

Working Conditions

Work typically is spent in contact with providers and clients outside the organizational unit. May work in homes and neighborhoods in "at risk communities" for violence and drug abuse.

Probationary Period

This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.

If you have questions about this advertisement, please contact Troy Sutherland at Troy.Sutherland@ky.gov or 502-564-9453.

An Equal Opportunity Employer M/F/D