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The Maternal ChildHealth 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).
If you are located in the
Reston, VA area, you will have the flexibility to telecommute* as you take
on some tough challenges.
- 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, and follow them
- 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 experience
- The MCH-PC must have a current and unrestricted (VA) RN License. This position is responsible for ensuring the efficacy 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 are achieved
- Lead and manage the day-to-day operations of the Healthy First Steps program
- Supervise direct reports and/or work closely with cross-functional owners to complete required work, including evaluations and performance improvement
- Review NICU admissions, including NAS infants, as well as prenatal and postpartum quality metrics and health outcomes
- Track and maintain data on pregnant members and newborns. Is knowledgeable about and is able to access/utilize various data sources within the HFS, C & S, and plan data bases.
- Ensure contract compliance and NCQA accreditation requirements are met, including state delivered reports, Policies and Procedures, program descriptions, member mailings and member education.
- Provide cross functional leadership with internal and external stakeholders supporting NICU, NAS, 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
- Provide oversight and management of any initiatives used within the HFS/Maternal Child Health programs (e.g. Baby Blocks)
- 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, Quality and Plan leadership
- 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, family planning services and lactation services through various communication mediums and events
- Partner with outreach to promote and present maternal events, activities and community education
- 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.)
- Support the Management 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. This includes case coverage for PTO/FML and overflow of caseloads
- Handle escalated or high risk cases received from the state, providers or members of the internal care team, including response to state and compliance
- 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
be rewarded and recognized for your performance in an environment that will
challenge you and give you clear direction on what it takes to succeed in your
role as well as provide development for other roles you may be interested in.
- Current and unrestricted (VA) RN License
- 5+ years Maternal Child Health and/or Pediatric clinical experience
- 5+ years' experience working with High Risk pregnancies
- 3+ years Care coordination and/or utilization management experience in a maternal child health population
- 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) with direct reports.
- Clinical program development and/or program oversight experience
- Proficiency with Microsoft Office Suite
- Intra-state travel up to 50%
- Advanced degree (MSN, MPH, APN, NP)
- Community and/or Public Health experience
- Management experience
- Excellent Communication and Writing skills
- All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.