Become a part of our caring community and help us put health first
 

Humana’s Maternal Child Health/Early and Periodic Screening, Diagnosis, and Treatment (MCH/EPSDT) Coordinator (Senior Quality Compliance Professional) will collaborate with all departments to ensure timely access of the delivery of high-quality maternal and postpartum care and EPSDT services for individuals under the age of twenty-one years, including the promotion of family planning
services and preventive health strategies. The EPSDT Coordinator will oversee all EPSDT activities and will be responsible for the ongoing development,
implementation, measurement, and improvement of Humana’s MCH/EPSDT delivery approach, with the aim of promoting culturally competent, timely, and appropriate maternal and child health services for our members. The Maternal Child/EPSDT Coordinator work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

POSITION RESPONSIBILITIES:

• Oversight of outreach to encourage enrollees to access preventative care and assist with appointment and transportation scheduling as necessary

• Review EPSDT services and assessments and HEDIS data to identify gaps in care and targeted interventions to increase utilization of well-child visits, exams, screenings and services

• Conducts medical record reviews of providers working with children under the age of twenty-one to ensure experience in addition treatment in children and adolescents
• Identifies and coordinates services for identified member needs, specific to Maternal/Child Health (MCH) and EPSDT
• Coordinates with community partners to support the delivery of EPSDT and MCH services, including development and implementation of population health programs and community events
• Conduct reviews of coverage for all members under the age of twenty-one to ensure appropriateness of benefits as described under the medically necessary treatment for EPSDT benefit.
• Supervises a group of clinical non-exempt associates; coordinates and provides day-to-day oversight to associates; Decisions typically are related to schedule, plans and daily operations. Performs escalated or more highly complex work
• Develops staff skills and competencies through ongoing education and training on topics related to EPSDT and MCH, including relevant state and federal requirements
• Collaborates with Provider Relations personnel to support Provider education efforts related to EPSDT and MCH

• Oversees EPSDT and MCH quality performance, including monitoring EPSDT performance measures and trends in MCH/EPSDT care delivery and developing performance improvement initiatives as appropriate
• Ensures compliance with state and federal requirements and NCQA standards that pertain to EPSDT and MCH
• Participates in quality committees and quality improvement related meetings with internal and external partners to advise on EPSDT and MCH performance and related quality initiatives

Use your skills to make an impact
 

Required Qualifications

Maternal Child Health / EPSDT Coordinator must meet one of the following:

• Virginia-licensed registered nurse OR
• physician’s assistant OR
• Bachelor's degree in health services OR Public Health, Healthcare Administration OR related field

Maternal Child Health / EPSDT Coordinator must meet all the following:

• 2+ years of supervisory or managerial experience in leading teams
• 5+ years' experience working in MCH (Maternal Child Health) or EPSDT (Early Periodic Screening diagnosis and Treatment)
• 3+ years’ experience working with Medicaid, CHIP and TANF populations
• 2+ years’ experience in Medicaid programs, managed care case management, quality improvement or pediatric office operations
• Excellent communication skills, both oral and written
• Comprehensive knowledge of Microsoft Word, Excel and PowerPoint
• Must reside and conduct work in the state of Virginia
• Must be available to travel occasionally to the Glen Alen, VA office as needed for business meetings

Preferred Qualifications

• Prior experience working with healthcare quality metrics in a fast past insurance or
  health care setting.
• Previous experience working with Clinical Auditing or Review
• Prior experience working with healthcare providers

Work-At-Home Requirements

To ensure Home or Hybrid Ho