Women and Children’s Regulatory Support Manager

Job Summary:

The Women and Children Heath Regulatory Support Manager is responsible for planning, organizing, leading and executing strategic initiatives and supporting regulatory requirements to align with overall business strategy for the Women and Children’s Health Team.

Essential Functions:

• Work closely with executives and leaders to ensure assigned initiatives align with business strategies, regulatory/contract/accreditation requirements and are properly resourced, and managed.

• Develop and provide comprehensive reporting & analysis with actionable recommendations and outcomes for assigned Women and Children’s Health(WCH) initiatives to senior management, stakeholders, and executive sponsors.

• Incorporates industry standards, best practice project management tools and techniques in Women and Children’s Health initiatives.

• Support the development and management of Women and Children’s Health  initiatives including data analysis to support the design, project plan development, workflow design, program tracking and implementation, ensuring assigned Women and Children’s Health initiatives are monitored and tracked as it relates to regulatory compliance.

• Manage and oversee execution of women, infant and children’s specific initiatives as directed by Ohio Department of Medicaid. This includes but not limited to the Medicaid School Program, Maternal Infant Support Program, Pathway Community HUBS, Reporting requirements and any ODM Regulatory deliverables or ad hoc requests

• Lead, direct and / or participate in Women and Children’s Health strategic initiatives

• Oversee and facilitate execution of agreements with community-based organizations interested in collaborating and partnering on maternal child initiatives to improve health outcomes.

• Coordinate the tracking and submission of process measures to related MCO improvement efforts in communities related to infant mortality reduction efforts, as well as women and children’s preventative  care.

• Monitor performance and processes of community partnerships within the CareSource network using reports generated from data/analytics, quality, population health and HEDIS to identify and disseminate best practices and to identify and address performance not being met as outlined within contracts/agreements. .

• Collaborate with internal stakeholders to use data to facilitate identification of gaps in clinical care, screenings, to implement best practices to optimize HEDIS rates, and develop and implement quality improvement activities to improve upon quality outcomes-measures for women, infants, and children.

• Partner with Provider-Contracting teams to collaborate with APM Providers (CMC, CPR, ACO’s and VBR) and all other providers to identify, prioritize and implement initiatives to engage members in completion of needed health care services and screenings.

• Perform any other job-related instructions, as requested

Education and Experience:

• Bachelor of Science in Nursing (BSN) or related field or equivalent work experience required

• Minimum of five (5) years of experience in nursing, social management, case management, discharge planning, care coordination and or community/home health environment required

• Minimum of five (5) years of clinical experience is required; 3 or more years of clinical experience in pediatrics/maternity care preferred

• Minimum of three (3) years of Medicaid/Medicare preferred

• Minimum of two (2) years of supervisory/preceptor experience preferred

• Preferred experience with project or technical leadership with proven demonstrated responsibility for development and implementation of strategic plans is required

Competencies, Knowledge and Skills:

• Data analysis and trending skills

• Proven ability to effectively interact at all organizational levels working with stakeholders and external partners

• Ability to manage and meet workloads and deadlines

• Proficiency in Microsoft Office tools, including Word, PowerPoint, Visio and Excel

• Ability to communicate effectively with diverse population

• Ability to multi-task and work independently within a team environment

• Ability to collaborate with other internal team members to optimize birth and health outcomes for pregnant members

• Ability to prioritize and adapt in a regulated environment; 

• Ability to maintain flexibility while leading innovation and organizational change;

• Knowledge of community and state support and advocacy resources for population served