AmeriHealth Caritas EPSDT Program Manager in Washington, District Of Columbia
EPSDT Program Manager
Location: Washington, DC
Primary Job Function: Medical Management
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Responsible for planning, developing, and implementing programs, initiatives and activities to help ensure the LOB meets and/or exceeds its strategic and contractually required EPSDT performance metrics. Also responsible for the timely completion and quality review of all EPSDT-related reporting. Directly completes or facilitates the completion of all required reports and collaborates with other key departments to facilitate cross-functional review well in advance of the due date to help ensure report quality and accuracy. Regularly interacts with Population Health/Integrated Care Management, Marketing and Community Outreach, Provider Network Management , District representatives, Corporate Medical Economics, Statutory Reporting and other functional areas across the LOB and Enterprise to:
1) Capture and track key EPSDT performance metrics;
2) Monitor and gauge the effectiveness of related activities, initiatives and programs;
3) Coordinate the accurate compilation, completion and submission of all required reports due to the DC Department of Health Care Finance (DHCF), other District of Columbia (DC) government agencies, and the Centers for Medicare and Medicaid Services (CMS) on or before their due dates. Serves as the primary lead and point of contact for EPSDT related communications with DHCF and other relevant DC government agencies.
In partnership with other relevant departments, e.g. Marketing, Outreach, Provider Network Management, etc., develops relationships and collaborates with providers, community-based organizations, schools and school based clinics, government agencies and other key stakeholders to align goals and synergize efforts to improve EPSDT utilization and performance. Identifies barriers to project and program success and works towards resolution by collaborating with appropriate stakeholders and the LOB leadership team to identify and implement appropriate mitigation. Ensures that all relevant programs are appropriately implemented, monitored, and measured. Analyzes EPSDT performance data from all available sources, utilizing that analysis to inform a data driven approach to improve both process and outcomes. Leads and participates in interdisciplinary committees to ensure cross-functional understanding and engagement for EPSDT and overall LOB success. Contributes to the development and distribution of provider and enrollee directed communications to improve awareness, understanding, and overall health of the LOB’s EPSDT eligible members and their families. Must be highly motivated, results/mission driven, and able to inspire the same in others.
3 to 5 years with a MCO involving activities described in position summary. Demonstrated skill at defining, managing and measuring of programs/work on a cross-functional, cross-organizational basis at the VP level and below. Demonstrated experience in applying strategic and critical thinking to broad scope of problems and business opportunities. Experience in independently determining implications and repercussions of problems and potential solutions. Proven project management skills and influencing skills at the VP level and below.
EOE Minorities/Females/Protected Veterans/Disabled