State of Montana Medicaid Child and Maternal Health Nurse (11701) in Helena, Montana

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/Materials required/

Materials Required of Applicants:

(To be considered in this pool, please submit the following)

  • Supplemental question:

Please describe how your education and employment experience qualify you for this position. Describe any training, experience, or special qualities that you have that are important for evaluating you as a candidate for this position.

  • Resume

(Please type responses in a Word document and attach to application. HELPFUL HINT: When attaching a document you must check the “relevant document” box to ensure your attachments are uploading correctly to the specific application. Please do not attach more than requested. If you have more than 25 attachments in the system you will need to email these to: hhshumanresources@mt.gov . Failure to attach the required material will conclude in an incomplete application. You must also keep those relevant boxes checked once you submit your application; if you uncheck the box with an active application it will delete the attachment.)

Job Overview: This position assures that Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program benefit provides comprehensive and preventive health care services for Medicaid members ages 20 and under. Responsibilities also include the administration of the EPSDT Program and corresponding EPSDT State Plan Amendments coordinating and promoting the health care of women during pregnancy, childbirth, and the postpartum period. The goal of this position is to continually improve the health status and well-being of children covered by Medicaid.

  • Major Duties and Responsibilities: *

Assures Medicaid programs meet requirements of the Federal Centers for Medicare and Medicaid Services (CMS) to provide comprehensive services and all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on federal guidelines.

  • Administers EPSDT State Plan Amendments and meets appropriate timeframes.

  • Manages and evaluates EPSDT services for Medicaid eligible children.

  • Promotes, manages, and coordinates child and maternal wellness initiatives.

  • Conducts regular EPSDT reviews with providers.

  • Develops educational materials for providers and members.

  • Represents Member Health Management Bureau on appropriate and related work groups.

  • Assists other Department entities in meeting EPSDT requirements by providing support, information, and training relating to Medicaid pediatric and maternal populations.

Ensures compliance with requirements of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) regarding strengthening quality of care and health outcomes, improving access to benefits, and program integrity and data collection.

  • Coordinates with Children’s Special Health Services and other public health programs, Part C, foster care, Head Start, Indian Health Services, and other providers and partners to assist providers in meeting required guidelines.

  • Reports EPSDT performance information annually via the CMS 416 report. Ensures accuracy of source reporting systems.

  • Provides direction and input in development and use of Healthcare Effectiveness Data and Information Set (HEDIS) measures.

  • Provides resources to bureau programs and providers to improve health literacy, using patient-centered technology and other proven communication methods.

  • Determines EPSDT performance measures, aligning measures with guidelines and requirements established by CMS. Prepares performance reports and recommends program improvements.

Researches, initiates, and coordinates a comprehensive approach to children’s health and health care. Considers the health and well-being of the whole child including the child’s physical environment, social service, and long-term needs.

  • Assures continuum of care, including health needs assessments, preventive screening, referrals, and completion of medical treatment and appropriate follow-up.

  • Facilitates the interaction among public programs, including public health, mental health, child welfare, education, special education, and early intervention, to illuminate gaps among services and critical linkages across child health systems.

  • Facilitates multi-sector engagement in children’s health care between coverage programs, primary care providers, and family members.

Develops programs and interventions to support comprehensive prenatal services, including universal risk screening, streamlined access to covered services, quality standards for Medicaid prenatal services and care management, and other services for at-risk pregnant Medicaid members.

  • Promotes early intervention to support health pregnancies and promote systems for assuring quality inpatient care, high-risk transports, and community follow-up for at-risk infants.

  • Coordinates with public health for the administration of the Medicaid State Plan Amendments for Medicaid’s Targeted Care Management programs for high risk pregnant women and children and youth with special health care needs to ensure coordination across programs, eliminating duplicative services, and service gaps. Is responsible for the division’s role in these the administration of these two State Plan Amendments.

  • Physical and Environmental Demands: *

Work is performed in an office environment with occasional travel required within Montana.

Knowledge, Skills and Abilities (Behaviors):

Required for the first day of work:

• Knowledge of the concepts and theories of the nursing and public health fields.

• Knowledge of utilization management, case management, or disease management principles.

• Knowledge of the principles related to physical and behavioral health of children and pregnant women.

• Knowledge of principles for providing needs assessments to meet quality standards, and evaluation of member and provider satisfaction.

• Ability to maintain confidentiality.

• Ability to develop constructive and cooperative working relationships with others, maintaining them over time.

• Excellent verbal and written communication skills, conflict resolution, and ability to communicate information and ideas so others will understand.

• Strong skills in planning, organization, and prioritization to meet work tasks.

• Ability to operate a personal computer, typing 45 wpm, and general office equipment as necessary to complete essential functions, including using spreadsheet, word processing, database, email, and other computer programs.

Required Minimum Education and Experience:

  • This position requires a Bachelor’s Degree in Nursing, with a current license to practice as a registered professional nurse in Montana.

  • Three years of job-related work experience in a healthcare related field.

  • Other combinations of related education and experience will be assessed on a case-by-case basis.

Job: *Healthcare

Title: Medicaid Child and Maternal Health Nurse (11701)

Location: Helena

Requisition ID: 18141573