Women & Children's Health Specialist II

Job Summary :

The Women & Children's Health Specialist II leads regional partnerships with OB providers to ensure at-risk pregnant mothers receive enhanced medical care to drive improved birth outcomes.

Essential Functions :

• Engage community of maternity care providers (Obstetricians, family medicine physicians, certified nurse midwives, nurse practitioners, FQHCs) through education and outreach to participate in the development of a maternal child home that mirrors the medical home model with regards to adoption of evidence-based practices, use of risk screening, coordination of care, and integration of case management for members at risk for poor outcomes
• Facilitate execution of agreements with practices interested in becoming maternal child medical homes (MCMH)
• Assure that local case management / care coordination entities develop and implement processes to achieve program goals
• Ensure the new MCMHs are connected to CareSource maternal child case management program and that maternal child case manager is assigned
• Monitor performance and processes of MCMHs, community partnerships within the CareSource network using reports generated from administrative, case management and chart audit data to identify and disseminate best practices and to identify and address outlier practices whose performance does not meet program standards.
• Develop and implement quality improvement activities, using data from the MCMH and Maternal Child Case Management programs
• Identify populations within CareSource membership that would benefit from focused maternal child case management and associated high risk and medical management programs
• Identify barriers to care completion and opportunities to improve quality of care and communicate barriers with CareSource business units to facilitate ongoing collaboration efforts
• Identify and partner with local community agencies, advocacy groups, etc. to develop relationships, enhance care coordination and improve health outcomes of pregnant members and infants and drive improved birth outcomes
• Collaborate with Center for Analytics to use data to facilitate identification of gaps in clinical care, screenings, to implement best practices to optimize HEDIS rates, increase provider satisfaction and drive HEDIS rate improvements
• Partner with providers to identify, prioritize and implement initiatives to engage members in completion of needed health care services and screenings
• Monitor and demonstrate impact of initiatives on HEDIS rate attainment by evaluating pre- and post-intervention data with providers; collaborate with providers to identify and prioritize subsequent targeted initiatives
• Utilize and expand Peer-to-Peer relationships between CareSource Medical Directors and providers to improve compliance with current evidence-based clinical practice guidelines
• Ensure alignment of all interventions with current evidence-based Clinical Practice Guidelines and the HEDIS Strategic Plan
• Identify provider coding opportunities to optimize both traditional and value-based reimbursement, reduce claims denials and integrate CareSource business partners in outreach efforts to increase provider satisfaction and drive improvement in HEDIS administration rates
• Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
• Perform any other job related instructions, as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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