Women & Children's Health Specialist II

This role requires Travel within Southern counties of Indianapolis.

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:

  • RN Associate degree required; Bachelor of Science in Nursing (BSN) or related field or equivalent work experience required
  • Minimum of five (5) years of experience in nursing, social management, case management, discharge planning, care coordination and or community/home health environment required
  • Minimum of five (5) years of clinical experience is required; 3 or more years of clinical experience in pediatrics/maternity care preferred
  • Minimum of three (3) years of Medicaid/Medicare preferred
  • Minimum of two (2) years of supervisory/preceptor experience preferred

Competencies, Knowledge and Skills:

  • Data analysis and trending skills
  • Ability to manage and meet workloads and deadlines
  • Able to provide timely feedback to CareSource team members and business partners and prioritize provider and member engagement initiatives
  • Intermediate proficiency level with Microsoft Office, Outlook, Word and Excel
  • Ability to communicate effectively with diverse population
  • Ability to multi-task and work independently within a team environment
  • Ability to collaborate with other internal team members to optimize birth and health outcomes for pregnant members
  • Knowledge of community and state support and advocacy resources for population served
  • Familiarity of state and federal healthcare regulations and environment
  • Critical listening and thinking skills and willingness to be flexible
  • Decision making and problem solving skills
  • Proper grammar use and phone etiquette
  • Strong organizational and time management skills
  • Ability to work within autonomous role, adapting and modifying plan of care of member as required

Licensure and Certification:

  • Current unrestricted license as a Registered Nurse (RN) in state of practice is required
  • Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated
  • Employment in this position is conditional pending successful clearance of a criminal background check.  If the criminal background results are unacceptable, the offer will be withdrawn or, if employee has started in position, employment in position will be terminated
  • To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is an essential requirement of this position.

CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have forty-five (45) days from their hire date to complete the required vaccination.

CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be reviewed by the CareSource Health & Wellness team.

Working Conditions:

  • Mobile Worker:  This is a mobile position, meaning that regular travel to different work locations is essential.  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
  • Reside in the same territory they are assigned to work in ; exceptions may be considered, due to business need
  • May be required to travel greater than 50% of time to perform work duties.  A valid driver’s license, car, and insurance are necessary for work related travel
  • Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
  • Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources
  • Perform regular travel to CareSource Headquarters for team meetings and other events as determined by Health Outcomes Management Team

Compensation Range:
$66,700.00 - $106,700.00

Compensation Type: