City/State
Culpepper, VAWork Shift
First (Days)Overview:
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Job responsibilities:
Responsible for facilitation, implementation and coordination of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Member Outreach Program and overall compliance with immunization and EPSDT examinations.
Serves as health plan resource for EPSDT/Well Child Program and all childhood exams, screenings, and vaccinations recommended by DMAS and per HEDIS measures.
Responsible for data entry and monitoring of reports to increase utilization of EPSDT services.
Maintains tracking system to identify new enrollees and children's non-compliance with EPSDT periodicity and immunization schedules.
Ensures access to periodic preventive health care for members under the age of 21 years by promoting and coordinating child wellness in alignment with DMAS, health plan, and other professional organization initiatives.
Conducts notifications of periodic screening requirements; develops educational materials and provides training to members/providers.
Triages members with special healthcare needs (CSHN) using appropriate screening tools and assessments.
Provides complex case management to members with complex needs.
Performs related field work and community engagement travel as needed to increase EPSDT awareness and compliance.
May assist with EPSDT policies/procedures and completing service authorizations.
Education
Associate's degree in Nursing preferred.
Bachelor's degree in Health & Human Services-related field or related experience in lieu of education accepted.
Licensed Practical Nurse (LPN) or Bachelor's prepared health professional strongly preferred.
Certification/Licensure
None required
Experience
MCO/HMO experience REQUIRED
3 years of clinical experience within the last 5 years
3 years of Medicaid/Medicare experience preferred
Familiar with HEDIS measures, EPSDT, and childhood immunizations charts and periodicity schedule. Utilization Management experience and Chart review/audit experience preferred
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-98959
Talroo – Health Plan
Keywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Care Coordinator, Nursing, Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, Virginia, VA, NOVA, Northern Virginia, Western, Virginia, Long-Term Services and Supports (LTSS), Waiver, Home Health. Licensed Practical Nurse, LPN
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.