There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) Positions in this function are responsible for supporting prevention interventions, coordination, data collection, and measurement of EPSDT services. This position is responsible for ongoing improvement activities associated with EPSDT eligible members, and reports to the Quality Management Leader or manager. In addition, the EPSDT Coordinator reviews, identifies, and works with management to resolve any problematic EPSDT issues. Primary Responsibilities:Phone calls and / or letters to providers to discuss issues and concerns In-person visits with member and or personal representative to review and address concerns and issues (including compliance issues) Training to providers, community organizations and other identified groups to improve understanding of our EPSDT program, changes to the program and provision of information regarding community resources On-site training visits to the providers when requested Assist the health plan in meeting EPSDT quality requirements Design and manage specific Quality Improvement (QI) interventions related to ensuring member receipt of EPSDT services and the creation of health improvement strategies under the direction of the QM Leader or manager Assist with monitoring of EPSDT data entry efforts and support monitoring and execution of follow-up, coordination of care and referral activities based upon EPSDT data obtained from EPSDT forms Support health plan coordination actions associated with State of Hawaii Department of Health Early Intervention Section (EIS) efforts to offer support and services for children with developmental delays or disabilities Support and monitor health plan responsibilities associated with the Vaccines for Children (VFC) program Develop provider and member education and training materials related to health promotion Meet with medical providers to discuss EPSDT, EIS or VFC activities, requirements or performance Create and review reports for submission to health plan leadership or regulators Summarize data or other information using Excel, MS Access or other data manipulation software Become a subject matter expert on EPSDT and EIS activities and serve in this capacity for the health plan Strong problem solving skills and the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Strong organizational skills and ability to work both independently and in teams with attention to detail Make formal presentations in front of committees or work groups Participate in cross-functional meetings and serve as a liaison for regulators or other community-based organizations Work independently on assigned projects under the supervision of the QM Leader or Manager Ensuring that key health plan staff (Service Coordination Team, Member Services and Provider Service Representatives) is aware of state and federal EPSDT requirements are an important part of the EPSDT Coordinators educational responsibilities The EPSDT Coordinator conducts trainings and answers questions for key health plan staff on EPSDT requirements and ensures understanding of state and federal EPSDT requirements. Educational and other information is shared through in-services, update notices and emails Conduct an annual evaluation of the processes and outcomes for EPSDT program and continuous quality improvement activities
Required Qualifications:Must be an Hawaii licensed nurse or physician's assistant or have a Master's degree in health services, public health, health care administration or other related field and / or a Certified Professional in Health Care Quality (CPHQ) 2+ years healthcare experience or other relevant experience Ability to Travel to physician offices and Quality Events locally as needed Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated areaPreferred Qualifications:Experience working with quality improvement activities Experience working for a Medicaid and / or Medicare health care regulator or insurance organization Experience working with the pediatric population Experience with EPSDT Careers 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: CPHQ, Quality, Nurse, RN, Master's degree, EPSDT, Medicare, Medicaid, pediatric, Honolulu, HI, Hawaii
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.