Senior Health Equity Specialist

Centene

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Candidates for this position must reside in the state of CA. Position Purpose: The Senior Health Equity Specialist is responsible for maintaining compliance with regulations and contractual obligations pertaining to Culturally and Linguistically Appropriate Services (CLAS) and Health Equity within State Health Programs, Commercial and Medicare product lines. The Senior Health Equity Specialist t ensures that culturally and linguistically appropriate services are provided to members, including identifying and implementing health equity initiatives, representing the health plan on national, regional and multi-plan initiatives and assessing operations for gaps. The Senior Health Equity Specialist leverages feedback from providers, members, vendors and community based organizations in the development of strategy and implementation and makes recommendations for CLAS and Health Equity efforts as aligned with contractual, accreditation and quality improvement opportunities to senior management. Implements and manages programs in compliance with contracts and regulations and monitors ongoing program performance to maintain compliance. Develops strategies and policies to deliver C&L services and maintain compliance with regulatory and contractual obligations. Develops, interprets and communicates policies, procedures, regulations and standards. Develops California State Health Programs (Medi-Cal) contract content for C&L services, for Medi-Cal, Healthy Families, and Healthy Kids products. Prepares P&P's for committee adoption. Implements activities to meet regulatory obligations. Monitors compliance with California regulations and State Health Programs contractual obligations Assesses operational gaps compared to new standards and makes recommendations to senior management. Represents Health net to Regulators and Accreditation Agencies, demonstrating the provision of culturally & linguistically appropriate health care services. Liaisons between community coalitions, California and local regulators, vendors, accrediting bodies and Health Net senior management to increase knowledge of new C&L standards and ensures contract requirements, goals and regulatory are met. Monitors/evaluates translation services and interpreter services. Evaluates externally translated materials from vendors and provides recommendations to vendor management/contracting. Identifies and resolves compliance issues/quality issues related to translating material. Identifies and resolves compliance issues/quality issues related to the provision of interpreter services. Reviews the translation process and translated materials for improvement opportunities. Manages Community Advisory Committees Develops regional goals, outcomes and objectives for Committees. Represents and articulates local or regional needs to senior management committees Develops C&L programs to enhance access to care for members and providers based on geographic, cultural, and linguistic data Develops teaching to standard modules for associates Develops teaching to standard modules for providers Reviews member and provider material for cultural and linguistic appropriateness. Monitors grievance and appeals processes for C&L issues. Proactively identifies areas of improvement for the department and participates in development of improvement plans.

Requirements

Bachelor's in Cultural Anthropology, Social Work, Medical Anthropology, Public Health or related field required.
5+ years of experience in government, health, or community programs.

Nice To Haves

Masters preferred.
Experience in managed care preferred.

Responsibilities

Maintaining compliance with regulations and contractual obligations pertaining to Culturally and Linguistically Appropriate Services (CLAS) and Health Equity within State Health Programs, Commercial and Medicare product lines.
Ensuring that culturally and linguistically appropriate services are provided to members, including identifying and implementing health equity initiatives, representing the health plan on national, regional and multi-plan initiatives and assessing operations for gaps.
Leveraging feedback from providers, members, vendors and community based organizations in the development of strategy and implementation and makes recommendations for CLAS and Health Equity efforts as aligned with contractual, accreditation and quality improvement opportunities to senior management.
Implementing and managing programs in compliance with contracts and regulations and monitors ongoing program performance to maintain compliance.
Developing strategies and policies to deliver C&L services and maintain compliance with regulatory and contractual obligations.
Developing, interpreting and communicating policies, procedures, regulations and standards.
Developing California State Health Programs (Medi-Cal) contract content for C&L services, for Medi-Cal, Healthy Families, and Healthy Kids products.
Preparing P&P's for committee adoption.
Implementing activities to meet regulatory obligations.
Monitoring compliance with California regulations and State Health Programs contractual obligations
Assessing operational gaps compared to new standards and makes recommendations to senior management.
Representing Health net to Regulators and Accreditation Agencies, demonstrating the provision of culturally & linguistically appropriate health care services.
Liaisoning between community coalitions, California and local regulators, vendors, accrediting bodies and Health Net senior management to increase knowledge of new C&L standards and ensures contract requirements, goals and regulatory are met.
Monitoring/evaluating translation services and interpreter services.
Evaluating externally translated materials from vendors and provides recommendations to vendor management/contracting.
Identifying and resolving compliance issues/quality issues related to translating material.
Identifying and resolving compliance issues/quality issues related to the provision of interpreter services.
Reviewing the translation process and translated materials for improvement opportunities.
Managing Community Advisory Committees
Developing regional goals, outcomes and objectives for Committees.
Representing and articulating local or regional needs to senior management committees
Developing C&L programs to enhance access to care for members and providers based on geographic, cultural, and linguistic data
Developing teaching to standard modules for associates
Developing teaching to standard modules for providers
Reviewing member and provider material for cultural and linguistic appropriateness.
Monitoring grievance and appeals processes for C&L issues.
Proactively identifying areas of improvement for the department and participates in development of improvement plans.