The position is responsible for the facilitation, implementation and coordination of the EPSDT Member Outreach Program and the overall compliance with immunization and EPSDT examinations. The position serves as the health plan resource for EPSDT/Well Child Program components including the monitoring of lead levels, and is the liaison between AzEIP, WIC, Head Start, Care1st Health Plan Arizona providers and Members.
The position makes recommendations for a selection of alternative methods and procedures, however the employee may be required to utilize independent judgment based on precedents set by similar situations and by referring issues requiring administrative review to the Director of Quality Management and the CMO.
• Minimum of two (2) years in Pediatrics background preferred
• Extended education/experience in a healthcare setting preferred
• HMO/Managed care experience preferred
• AHCCCS experience helpful
• Chart review/audit experience preferred
• Must demonstrate excellent written and verbal communication skills
• Good communication skills in both Spanish and English required
• Must be highly organized with good attitude
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. The primary responsibility for this position is to ensure access to periodic preventive health care for members 0-21 years by:
a) Promoting and coordinating child wellness initiatives
b) Conducting ongoing notifications of periodic screening requirements to providers and members either via monthly mailings and/or telephone calls
c) Developing and implementing an ongoing outreach program strategy to promote EPSDT visits
d) Tracking immunizations for the 12-24 month old members
e) Tracking specialty service referrals and correlating with service dates
f) Conducting EPSDT audits on a rotating schedule, as per the EPSDT guidelines
g) Developing educational materials and/or providing training to providers and/or Members
h) Recommends and evaluates potential incentive programs for components of EPSDT/Well Child program
i) Developing quarterly EPSDT participation reports
j) Represents Care1st Health Plan Arizona at community coalitions and at AHCCCS meetings
k) Collaborates with the MCH/EPSDT Coordinator Supervisor and the EPSDT Outreach Coordinator to effectively manage the EPSDT membership
l) Participate in the implementation of any required newly developed health initiatives
2. Adheres to institutional polices to assure consistency and quality health care delivery.
a) Adheres to Care1st policies and procedures
b) Assist in development and necessary revisions of EPSDT/Wellness and Dental policies and procedures
c) Assumes responsibility for attendance at meetings
d) Assumes responsibility for a professional appearance
e) Adheres to an ethical code of confidentiality
3. Ensures professional self development.
a) Participates in a formal self evaluation process
b) Demonstrates currency of practice
4. Supports and adheres to Care1st philosophy that provision of quality service to members and provides is the highest priority.
a) Maintains a professional demeanor in all dealings with providers and co-workers
b) Treats patient information in a confidential manner
c) Communicates with other personnel/departments in a professional, caring and effective manner
5. Contributes to continuous quality improvement activities.
a) Participates, as appropriate, in department’s continuous quality improvement plan by measuring assessing and improving performance in order to impact the overall quality of clinical and support activities/processes
6. Performs other related job duties as assigned.
• Understands and abides by all departmental policies and procedures as well as the organization’s Corporate Integrity Program.
• Attends mandatory Corporate Integrity Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class.
• Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position.
• Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare.
• Represents the organization in a positive and professional manner in the community.
• Maintains organizational confidentiality at all times.
• Complies with all organizational policies regarding ethical and compliant business practices.
• Appearance is professional and exemplary at all times.