EPSDT RN Coordinator

AlohaCare; United States; On-site; USD 78,000 - 98,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

401k employer contribution

Referral bonus

Pre-tax transportation

Parking

Job summary

AlohaCare in Hawaii seeks an EPSDT RN Coordinator to serve as a liaison between the MQD and AlohaCare, ensuring timely access and coordination of EPSDT services for Medicaid members. Responsibilities include developing desk level procedures, coordinating with Population Health and other internal teams, providing annual training to providers, and representing AlohaCare at community EPSDT events.

The role requires Hawaii RN licensure, strong communication, and travel within Oahu to support

Qualifications

• Licensed RN in the State of Hawaii.
• Strong interpersonal and facilitation skills with patients and teams.
• Excellent written and oral communication in a fast-paced environment.

Responsibilities

• Coordinates EPSDT program and ensures timely access to services.
• Develops procedures and revises policies for EPSDT.
• Trains providers and staff on EPSDT policies and reports.
• Represents AlohaCare at EPSDT-related community events and collaborations.
• Maintains confidentiality and compliance with regulations.

Skills

Interpersonal skills

Communication

Time management

Problem solving

Education

RN license Hawaii

Tools

Microsoft Word

Microsoft Excel

Outlook

PowerPoint

Job description

The Company AlohaCare is a local non profit health plan serving Hawaiis low income residents with free Medicaid and dual Medicare health insurance coverage Our members include children seniors and adults residing on all islands We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care Our approach is to meet the whole person health and social needs of members Through our community partnerships we offer innovative services such as connection to social service agencies Native Hawaiian healing services and in home primary care for qualified members Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all We are Hawaiis third largest health plan and offer a wide network of quality primary care specialists hospitals pharmacies and among many other providers across the state.

The Culture

AlohaCare employees have a passion for helping Hawaiis most underserved communities Our caring culture is fundamental to our company wide team approach to providing high quality services We support our employees with a supportive and positive work environment healthy work life balance continuous communication and a generous benefits package AlohaCares leadership empowers and engages its employees by recognizing outstanding job performance and collaboration We share organization wide updates during quarterly All Staff meetings We encourage participation in volunteer and educational opportunities We put a high value on honesty respect and trust building We encourage open door two way and frequent communication AlohaCares comprehensive benefits package includes low cost medical dental drug and vision insurance paid time off 401k employer contribution referral bonus and pretax transportation and parking program.

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 AlohaCares 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 providersstaff 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 PCPs 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 ie mass mail outs communications etc
• Coordinates with State and other programsDOH Children with Special NeedsTransition for EIS Early Intervention ServicesCommunity Integration Services Plus CISCoordination of dental screening and diagnostic services in the thirty 30 days prior to release or as soon as is practicable following release; andTargeted Case Management services which are encompassed in the definition of Case Management in 413 in the thirty 30 days prior to release and for at least thirty 30 days following releaseDHS State of Hawaii Organ and Tissue Transplant SHOTTDHS Foster CareChild Welfare Services CWSCoordinates referralsDentalDiagnostic servicesBehavioral HealthcareSpecialty Care including OBGYN dermatology endocrinology cardiology pulmonology and physicaloccupationalspeechOtherAll other duties assigned
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures
• Responsible for maintaining AlohaCares 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 teamsprojects and in a matrixed environment
• Possesses excellent time management and organizational skills; is dependent 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 faxcopy 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 andor 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 environmentMay 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 78000 98000 annually.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws Our policy prohibits discrimination and harassment because of race color religion sex including gender identity or expression pregnancy age national origin ancestry marital status arrest and court record disability genetic information sexual orientation domestic or sexual violence victim status credit history citizenship status militaryveteran status or other characteristics protected under applicable state and federal laws regulations andor executive orders.