Manager of ESPDT - Brentwood, TN - Full-time / Part-time

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care.
 
The Clinical Operations team is seeking a Manager of EPSDT.  The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides health care services to children younger than 21 who are enrolled in Medicaid. In this role, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work.(sm) 
 
This is an office based position in Brentwood, TN.
 
Primary Responsibilities:    

Oversees the implementation of plan EPSDT quality improvement program
Works to coordinate initiatives within C&S Clinical Operations in order to improve EPSDT performance and to close gaps in care
Collaborates with C&S Quality on EPSDT initiatives to improve outcomes
Manages EPSDT Playbook or work plan programs and activities
Collaborates across business segments to achieve goals and targets
Develops and maintains positive relationships with State client and external organizations
Helps ensure the creation, integration, maintenance, approval of the EPSDT Playbook or work plans
Continuously monitors EPSDT interim results and adjust programs to insure meeting targeted goals
Manages compliance with TennCare Kids contractual requirements and annual EPSDT audit
Supports PIPS, accreditation and regulatory audits as needed
Interviews, hires, and supervises EPSDT staff
Develops, mentors, and coaches staff

Required Qualifications:        

Undergraduate degree
Active, unrestricted RN license in the state of Tennessee
At least 3 years of experience with EPSDT
3-5 years of experience in a progressive quality organization, within health care industry
3+years of managerial experience with direct reports
3+ years of experience with demonstrated functional knowledge of process improvement, quality improvement and change management
Strong written and oral communication skills with internal and external partners and employees
Prior experience creating reports related to quality improvement/performance outcomes
Preferred Qualifications:

Medicaid / TennCare experience
Performance Driven
Experience with Corrective Action Plans
Strong influencing and negotiation skills
Able to make independent decisions
Change management experience and demonstrated skills
Demonstrated staff development skills
Strong team building, collaboration and motivational skills
Results-oriented
Knowledgeable of the managed care/health insurance industry, products and services
Knowledge of NCQA accreditation standards, HEDIS, EPSDT, STARS, Regulatory Adherence and Performance Improvement Projects
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.
 
 
Job Keywords: RN, Registered Nurse, Quality, Manager, Quality Manager, HEDIS, NCQA, EPSDT, Quality Improvement, Performance Improvement, Case Management, Middle, TN, Nashville, Brentwood, Tennessee, Davidson CountyÂ