Clinical Practice Consultant-EPSDT Job Listing at HCSC in Chicago, IL (Job ID R0037310)

Description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for supporting our quality improvement imperatives specific to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits for Illinois Medicaid members. This role will be responsible for defining our IL Medicaid school-based health center engagement strategy, and will drive/execute pediatric population health efforts, in collaboration with pediatrician providers, dental providers, and relevant pediatric specialist groups. In collaboration with the Medical Director and Quality CPC teammates, this position will drive provider engagement efforts to improve EPSDT and HEDIS rates for IL Medicaid members. This may include but is not limited to efforts such as: create provider education materials, deploy training and assistance to providers for EPSDT rate improvements; implementing provider-based member outreach and engagement campaigns; perform routine medical record audits to assess providers' compliance with EPSDT periodicity guidelines/preventive pediatric guidelines, including required referral documentation and follow-up; support providers with establishing and/or enhancing their provider supplemental data submissions; provide guidance and support to Network and Value-Based Care teams to incentivize provider EPSDT efforts; collaborate internally with member-facing staff to optimize engagement of members and providers for completion of EPSDT services. This role will provide ongoing and annual evaluation of the effectiveness of the overall IL Medicaid EPSDT program, regularly analyzing EPSDT rates, including service and referral completions, to assess effectiveness of member and provider engagement efforts and will proactively identify and drive continuous improvement efforts.

JOB REQUIREMENTS:

• Registered Nurse (RN) OR Physician's Assistant OR Nurse Practitioner with current, unrestricted license to practice in the state of operations.
• 4 years' experience in health insurance, managed care or medical group experience.
• Knowledge of federal and accreditation standards and regulations for the health insurance industry
• Experience in designing clinical programs
• Experience conducting presentations for member and/or provider training.
• Proven ability to work collaboratively with physicians
• Ability to work independently
• Effective communication and written skills and ability to communicate and influence internal and external customers at all levels of the organization
• PC skills and familiarity with various software packages including spreadsheets and presentations
• Ability to travel including overnight stays.

*CA

#LI-HYBRID

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

 Apply on company website