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 Program Coordinator (MCH - PC) 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 is responsible for ensuring the efficiency of the HFS program through various management, oversight, and program development activities. The MCH - PC works closely with the Health Plan clinical leaders including the CMO, Health Services director and the Quality Director to achieve the goals and objectives of the HFS program. However, it is ultimately the responsibility of the MCH - PC to manage the maternal child health activities and ensure compliance, quality, health outcomes and medical expense objectives for the Health Plan is achieved. Candidate must be able to work in either the Philadelphia ( Wanamaker Bldg.), or our Pittsburgh ( 2 Allegheny Center) office Primary Responsibilities:Developing strategic relationships with community based organizations that provide maternal and / or child health related services to Medicaid populations Setting the direction for and leading team meetings with the locally - based team of CPCs, Transformation Consultants, Care Coordinators and CHWs who deliver the maternal health program Monitoring, measuring and managing performance against state compliance, quality and affordability goals Developing innovative approaches to improve engagement and overall program performance Representing the program to state regulators, providers, community partners and Health Plan senior leadership Tracking HEDIS compliance and making improvements to maximize associated incentive dollars captured Understanding contractual and NCQA requirements and ensuring cross-functional staff are educated on these. 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 (60 - 70%)Lead and manage the Pennsylvania health plan day - to - day operations of the Healthy First Steps program Work closely with cross - functional owners to complete required work Review NICU admissions, as well as prenatal and postpartum quality metrics and health outcomes Track and maintain data on pregnant members and newborns Ensure contract compliance and NCQA accreditation requirements are met Provide cross functional leadership with internal and external stakeholders supporting NICU and other specialty MCH program components Provide thought leadership and annual evaluation of program design and efficacy as well as development of work plans to address performance improvement Initiate program improvement projects and activities to drive outcomes for pregnant women and children Serve as an external facing liaison among various stakeholders supporting Maternity / NICU services to drive partnerships (e.g. public health departments, school - based health centers, behavioral health organizations, FQHCs / ACOs) and innovative strategies that will promote and enhance maternal and child health Complete and maintain data analysis and reporting on MCH program and outcomes on a routine basis including presentation to national MCH lead Implement policies and procedures to align with program goals and compliance requirements 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 (30 - 40%)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 Pennsylvania RN License 4+ years Maternal and / or Pediatric clinical experience 3+ years Care coordination and / or utilization management experience 2+ years' experience working in Medicaid Intermediate experience with Microsoft Office Suite Must be able to work in either our Philadelphia office ( Wanamaker Bldg.), or our Pittsburgh ( 2 Allegheny Center) officePreferred Qualifications: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 Advanced degree (BSN, MSN, MPH) 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, utilization management, Maternal Child Health Program, Healthy First Steps, Providers, NCQA, HEDIS, clinical, Pennsylvania, Pittsburgh, Delaware, New Jersey, PA
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.