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 ORphysician’s assistant ORBachelor'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 teams5+ 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 populations2+ years’ experience in Medicaid programs, managed care case management, quality improvement or pediatric office operationsExcellent communication skills, both oral and writtenComprehensive knowledge of Microsoft Word, Excel and PowerPointMust reside and conduct work in the state of VirginiaMust 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 ReviewPrior experience working with healthcare providers

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.Satellite, cellular and microwave connection can be used only if approved by leadership.Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information

Interview Format

 As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

 If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed)

Social Security Number Statement

Humana value's personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

 The SMS Text interview, will ask you a series of questions to which you will be using your Cell phone OR Email to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$78,400 - $107,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.