For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The Maternal Child Health Care Coordinator has strategic oversight, cross - functional management and responsibility for the delivery of quality and affordability results for the Health Plan's maternal child health program known as Healthy First Steps (HFS). This position it is ultimately the responsibility to manage the maternal child health activities and ensure compliance, quality, health outcomes and medical expense objectives for the Health Plan are achieved. Primary Responsibilities:Developing strategic relationships with community based organizations that provide maternal and/or child health related services to Medicaid populations Designing and leading quality improvement projects related to maternal child health Ensuring all components of the program, delivered by the ACO Transformation Consultants, Quality CPCs, Call Center Advocates, Optum CHWs and external providers and community - based organizations tie together into a comprehensive and seamless member experienceProgram Oversight Responsibilities:Review NICU admissions, as well as prenatal and postpartum quality metrics and health outcomes Track and maintain data on pregnant members and newborns Initiate program improvement projects and activities to drive outcomes for pregnant women and children Ensure member and provider materials specific to the HFS program meet all state and regulatory guidelines Represent the health plan and provide subject matter expertise at internal clinical and quality meetings, regulatory meetings, and any relevant community partner meetings, workgroups, etc. Monitor and oversee execution of performance and activities to improve health and quality outcomes and effective medical management (e.g., HEDIS, infant mortality, pre - term births, NICU admissions) Promote preventive care and family planning services through various communication mediums and events Identify and implement population health strategies (e.g. inter - conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)Clinical Responsibilities:Manage highly complex members as part of an inter - disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc. Handle escalated or high risk cases received from the state, providers or members of the internal care team Ensure effective transitions of care occur and referrals to community - based services and resources are addressed Consult with care team to address specialty care services, community - based resources, and other member complex care needs Assist in identification of pregnant women and children including those with special health care needs and access / linkages to appropriate care Provide consult, training and technical assistance in the development of care plans with measurable goals and outcomes
Required Qualifications:Current and unrestricted RN License in the state of MO 4+ years Maternal and/or Pediatric clinical experience 2+ years' experience working in Medicaid 2+ years leadership experience (e.g., Review work of others, Serve as an expert in their field, Serve as a mentor and leader, Lead functional or segment teams or projects, Motivate and inspire team members) Clinical program development and / or program oversight experience Proficiency with Microsoft Office Suite Intra - state travel up to 50%Preferred Qualifications:Advanced degree (BSN, MSN, MPH) 3+ years Care coordination and / or utilization management experience Community and / or Public Health experience Management experience Excellent Communication and Writing skillsCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: RN, Registered Nurse, Nurse, Maternal, Pediatric, maternal child, Maternal Child Health Program, Care coordination, case management, case manager, care coordinator, utilization management, Medicaid, leadership, management, manage, supervisory, supervise, program coordinator, program manager, program development, mentor, lead, clinical program development, community health, public health, program oversight, St Louis, Kansas City, Springfield, St Joseph, Cape Girardeau, Jefferson City, Columbia, Maryland Heights, MO, Missouri
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.