Ensure that members eligible for Medicaid benefits receive outreach for informing, screening, tracking, diagnostic and treatment services available under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit
Responsible for execution, monitoring and reporting of Quality or Preventive Health Programs and strategies (i.e., School Based Health Centers, Telehealth), including supporting members with educational materials according to clinical best practice guidance
Participate in quarterly market Quality Improvement and population health management workgroups
Facilitate completion of the annual evaluation report for assigned market/product
Attend telephonic Health Partner meetings with top providers; engage in population and rural provider strategy
Telephonically contact eligible members and providers to discuss all preventive care needs, benefits and their current gaps in care
Ensure that contractual/regulatory requirements for prevention services are met
Collaborate with enterprise quality for all prevention services, analysis of data and reporting
Be fully versed in individual state clinical/programmatic contract management requirements
Collaborate closely with members’ assigned case managers to coordinate care and programs
Prepare weekly, monthly, quarterly and annual reports of outreach activities
Perform any other job duties as assigned

Bachelor’s degree in business or health care field or equivalent years of relevant work experience is required
Minimum of three (3) years of experience in healthcare, community health or related field is required
Managed care organization experience is preferred
Experience working with data and data analytics is preferred
Proficient in Microsoft Office including PowerPoint, Word and Excel
Ability to communicate and interact with individuals at varying skill levels, educational and cultural backgrounds
Familiarity of state and federal healthcare regulations and environment
Data analysis and trending skills
Strong presentation skills
Excellent time management skills and ability to manage and meet workloads and deadlines
Ability to work independently and within a team environment
Critical listening and thinking skills
Proper grammar usage and phone etiquette
Customer service oriented
Ability to be flexible.

Prevention Health Specialist

Key skills