Behavioral Health Clinical Liaison
CVS HealthSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must reside in the Commonwealth of Virginia and possess an active, unrestricted Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) license in Virginia. They should have at least two years of experience in Maternal Child Health (MCH) or Early Periodic Screening Diagnosis and Treatment (EPSDT), along with two years of experience in Medicaid programs, managed care case management, quality improvement in healthcare, or pediatric office operations. Intermediate proficiency in Microsoft Office programs, including Word, Excel, and PowerPoint, is required, as well as excellent communication skills, both oral and written, the ability to work independently, and self-direction.
Responsibilities
The Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) will collaborate with all departments to ensure timely access and delivery of high-quality maternal and postpartum care and EPSDT services for individuals under twenty-one, promoting family planning and preventive health strategies. They will conduct telephonic outreach to encourage preventative care access and assist with scheduling, review EPSDT services and assessments and HEDIS data to identify care gaps, conduct medical record and claims reviews of providers, identify and coordinate services for member needs, coordinate with community partners, review coverage for members, collaborate with Provider Relations, ensure compliance with regulations and standards, and participate in quality committees and improvement meetings.
Skills
Maternal-Child Health
EPSDT
Medicaid
HEDIS
Medical Record Review
Claims Review
Population Health
Community Outreach
Preventive Care
Care Coordination
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees