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Maternal Child Health Program CoordinatorCompany UnitedHealth Group
Location Jacksonville, FL
Update 8 Day ago
The Maternal Child Health 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). This includes, but is not limited to the following:
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 Florida 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.
Program Oversight Responsibilities (60-70%)
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
Review NICU admissions, as well as prenatal and postpartum quality metrics and health outcomes
Track and maintain data on pregnant members and newborns
Ensure contract compliance and NCQA accreditation requirements are met
Provide cross functional leadership with internal and external stakeholders supporting NICU 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
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
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 and family planning services through various communication mediums and events
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.)
Clinical Responsibilities (30-40%)
Manage 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.
Handle escalated or high risk cases received from the state, providers or members of the internal care team
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
Current and unrestricted Florida RN License
4+ years Maternal and / or Pediatric clinical experience
3+ years Care coordination and / or utilization management experience
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)
1 year management experience in a healthcare environment
1 year of Program development or Program implementation experience
Clinical program development and / or program oversight experience
Proficiency with Microsoft Office Suite
Intra-state travel up to 50%
Advanced degree (BSN, MSN, MPH)
Community and / or Public Health experience
Project Management experience
Excellent Communication and Writing skills
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.