Apply online at http://www.alohacare.org/Careers/Default.aspx The Opportunity: The EPSDT (Early, Periodic, Screening, Diagnostic, and Treatment) RN Coordinator serves as a liaison between the Med Quest Division (MQD) and AlohaCare via the EPSDT Advisory Committee. This role ensures timely access and coordination of services for all members who qualify for the EPSDT Medicaid benefit.
Primary Duties and Responsibilities: - Coordinates EPSDT program for the health plan
- Attends all EPSDT Advisory Committee meetings chaired by MQD and effectively communicates relevant information back to appropriate business owners within the health plan
- Develops Desk Level Procedures (DLPs) and revises AlohaCare policies and procedures for EPSDT.
- Ensures that all State mandated reports for EPSDT (CMS 416) and dental reports are completed in a timely manner
- Responsible for developing and implementing EPSDT Program and EPSDT Program Evaluation
- Collaborates with Population Health Management and other internal departments for Keiki Wellness and other services
- Represents AlohaCare at community EPSDT functions that are congruent with AlohaCare's mission and goals.
- Serves as a resource for providers and AC staff to improve EPSDT services.
- Attends coalition meetings of groups related to pediatric health care to remain current with health issues and trends.
- Identifies community and other resources available to meet pediatric preventive health needs.
- Provides annual training to providers/staff on EPSDT.
- Educates providers through mailings and Provider Newsletter articles and Provider Manual.
- Educates and coordinates care for members related to EPSDT services.
- Coordinates member care when requested by PCPs for members who are delayed in receiving EPSDT visits, immunizations, or follow-up.
- Identify members with delayed EPSDT services from state mandated reports or site visits, and follow-up with PCP's or members.
- Educates targeted members through phone calls as needed.
- Participates in Quality Improvement activities (including HEDIS, CAHPS, etc.)
- Facilitates EPSDT document preparation and maintenance, which enables prompt response to requests for reports concerning EPSDT. This includes clinical studies, regulatory agency audits, and surveys that apply to EPSDT.
- Analyzes specific reports and studies for variance and other statistical data, outlier reporting of findings and recommendations for QI activities related to EPSDT.
- Participates in facility and medical record review audits as needed, particularly for providers who have not met standards in previous EPSDT medical record reviews
- Drives target outreach related to MQD EPSDT requirements (i.e. mass mail outs, communications etc.)
- Coordinates with State and other programs
- DOH - Children with Special Needs
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- Transition for EIS (Early Intervention Services)
- Community Integration Services Plus (CIS+)
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- Coordination of dental screening and diagnostic services in the thirty (30) days prior to release or as soon as is practicable following release; and
- Targeted Case Management services, which are encompassed in the definition of Case Management in • 4.13, in the thirty (30) days prior to release and for at least thirty (30) days following release.
- DHS • State of Hawaii Organ and Tissue Transplant (SHOTT)
- DHS • Foster Care/Child Welfare Services (CWS)
- Dental
- Diagnostic services
- Behavioral Healthcare
- Specialty Care including OBGYN, dermatology, endocrinology, cardiology, pulmonology, and physical/occupational/speech
- Other
- All other duties assigned
- Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
- Responsible for maintaining AlohaCare's confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title
Requirements: - Licensed RN in the State of Hawaii
- Minimum of 2 years of clinical experience.
- Demonstrates ability for assessment, evaluation and interpretation of medical information.
- Understands the concepts of comprehensive pediatric health care.
- Ability to work independently and coordinate with the work of other personnel effectively.
- Demonstrates the ability to work well with members, physicians and other health care providers.
- Achieves results, builds trust, communicate effectively, customer and quality focused.
- Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
- Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
- Professional telephonic etiquette skills .
- Ability to solve problems, analyze, think critically and make good judgment.
- Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
- Able to work independently with minimal supervision.
- Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
- Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
- Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint Experience in the operation of general office equipment to include PC, fax/copy machine and phone system .
- Able to travel within Oahu and occasionally to neighboring islands.
- Access to own transportation for provider site record reviews or meetings
Preferred Requirements: - Prior medical management or quality improvement experience in managed care
Mental, Physical and Environmental Demands: - Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
- In office working environment.
- May require prolonged sitting- up to 4 hours.
- Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.?
Salary Range: $78,000 - $98,000 annually
