Humana
Cincinnati, OH Remote Full Time
Job Posting for EPSDT Maternal Child Health Professional (Medicaid) – Remote Ohio at Humana
The Senior Quality Compliance Professional works with physicians/physician groups to ensure highest accountability of compliance and quality. The Senior Quality Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
The Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, and evaluate activities to monitor and continuously improve EPSDT and maternal health services and rates for Ohio Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis skills and a strong knowledge of EPSDT and maternal health requirements. The Senior Quality Compliance Professional is frequently required to interpret and analyze data to identify new creative interventions to increase EPSDT screening rates, improve access to pregnancy related services, independently determine an appropriate course of action, and present these ideas/plans to governance teams/committees. They assess educational needs of internal and external teams around EPSDT and maternal health services in order to develop and implement plans to increase knowledge.
The primary functions of this role include:
- Ensure member receipt of all EPSDT/HealthChek Services;
- Ensure member receipt of maternal health and postpartum care;
- Promote family planning services;
- Promote preventive health strategies;
- Identify and coordinate assistance for identified member needs specific to maternal/child health and EPSDT;
- Interface with community partners and pregnancy related services coordinators;
- Participate in EPSDT, maternal health and child quality performance improvement efforts; and
- Must reside in the state of Ohio and be available to travel for periodic meetings
Required Qualifications
Senior Quality Compliance Professional must meet one of the following requirements:
- Unrestricted Registered Nurse in the State of Ohio OR
- Physician’s Assistant OR
- Master’s degree in health services, public health, or health care
- administration or another related field OR
- Certified Professional in Health Care Quality (CPHQ) OR
- Certified Health Care Quality Management (CHCQM)
Senior Quality Compliance Professional must meet all of the following:
- At least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement
- Prior experience in a fast paced insurance or health care setting
- Knowledge of EPSDT and Child Health Services
- Knowledge of Maternal and Pregnancy related services
- Understanding of healthcare quality measures (example HEDIS)
- Comprehensive knowledge of Microsoft Office Outlook, One Note, Visio, Word and PowerPoint
- Advanced Excel experience (pivot tables, charts, formulas)
- Excellent communication skills, both oral and written, ability to present to large groups
- 10% travel for meetings within the State of Ohio (see additional information)
- For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
- Provide proof of full vaccination or commit to testing protocols OR
- Provide proof of applicable exemption including any required supporting documentation
- Medical, religious, state and remote-only work exemptions are available.
Work At Home Requirements
- Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
- Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
Preferred Qualifications
- Certified Professional in Health Care Quality (CPHQ)
- Advanced Practice Provider (Physician Assistants; Nurse Practitioner, Certified Nurse Midwife)
- Experience developing provider and member education
- Knowledge of Humana’s internal policies, procedures and systems
Additional Information
Onsite Travel
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
#ThriveTogether #WorkAtHome
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40