About The Position
Sentara Health Plans is hiring a Care Coordinator/ Licensed Practical Nurse (LPN) for LTSS Waiver/ Home Health in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, and Gordonsville, VA. This is a full-time, permanent position with standard working hours of 8 am to 5 pm EST, Monday through Friday. The role involves facilitating, implementing, and coordinating the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Member Outreach Program, ensuring compliance with immunizations and EPSDT examinations. The Care Coordinator serves as a health plan resource for the EPSDT/Well Child Program, childhood exams, screenings, and vaccinations recommended by DMAS and per HEDIS measures. Responsibilities include data entry, monitoring reports to increase EPSDT service utilization, and maintaining a tracking system for new enrollees and non-compliance with schedules. The position ensures access to preventive health care for members under 21 by promoting and coordinating child wellness in alignment with DMAS and other initiatives. This includes conducting notifications of screening requirements, developing educational materials, and providing training to members and providers. The role also involves triaging members with special healthcare needs (CSHN) using screening tools and assessments, providing complex case management, and performing field work and community engagement travel to increase EPSDT awareness and compliance. Assistance with EPSDT policies/procedures and completing service authorizations may also be required.
Requirements
- MCO/HMO experience REQUIRED
- 3 years of clinical experience within the last 5 years
- Familiar with HEDIS measures, EPSDT, and childhood immunizations charts and periodicity schedule.
Nice To Haves
- Associate's degree in Nursing preferred.
- Bachelor's degree in Health & Human Services-related field or related experience in lieu of education accepted.
- Licensed Practical Nurse (LPN) or Bachelor's prepared health professional strongly preferred.
- 3 years of Medicaid/Medicare experience preferred
- Utilization Management experience and Chart review/audit experience preferred
Responsibilities
- Facilitation, implementation, and coordination of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Member Outreach Program and overall compliance with immunization and EPSDT examinations.
- Serve as health plan resource for EPSDT/Well Child Program and all childhood exams, screenings, and vaccinations recommended by DMAS and per HEDIS measures.
- Data entry and monitoring of reports to increase utilization of EPSDT services.
- Maintain tracking system to identify new enrollees and children's non-compliance with EPSDT periodicity and immunization schedules.
- Ensure access to periodic preventive health care for members under the age of 21 years by promoting and coordinating child wellness in alignment with DMAS, health plan, and other professional organization initiatives.
- Conduct notifications of periodic screening requirements; develop educational materials and provide training to members/providers.
- Triage members with special healthcare needs (CSHN) using appropriate screening tools and assessments.
- Provide complex case management to members with complex needs.
- Perform related field work and community engagement travel as needed to increase EPSDT awareness and compliance.
- Assist with EPSDT policies/procedures and completing service authorizations.
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
