Job Overview
Location
Remote Ohio
Job Type
Full-time
Category
Product Management
Date Posted
June 18, 2026
Full Job Description
đź“‹ Description
- • Ensure all Ohio Medicaid enrollees receive required EPSDT/HealthChek services, including preventive screenings and developmental assessments.
- • Guarantee access to comprehensive maternal health and postpartum care services for eligible members.
- • Promote family planning services and preventive health strategies to improve long-term maternal and child health outcomes.
- • Identify and coordinate targeted assistance for members with specific maternal or child health needs, connecting them to appropriate resources.
- • Interface with community partners and pregnancy-related services coordinators to enhance service delivery and member support.
- • Participate in EPSDT, maternal health, and child quality performance improvement initiatives using data-driven methodologies.
- • Analyze complex health data to identify trends, gaps in care, and opportunities for increasing EPSDT screening and maternal health service utilization rates.
- • Develop and implement creative, evidence-based interventions to improve health outcomes and compliance with state and federal EPSDT requirements.
- • Assess educational needs of internal teams and external stakeholders regarding EPSDT and maternal health services, then design and deliver targeted training and resources.
- • Interpret and apply healthcare quality measures such as HEDIS to evaluate program effectiveness and guide improvement efforts.
- • Utilize advanced Excel skills—including pivot tables, complex formulas, and data visualization—to generate reports and support decision-making.
- • Independently determine appropriate courses of action based on data analysis and regulatory requirements, and present recommendations to governance committees.
- • Maintain strict compliance with HIPAA regulations by working from a dedicated, interruption-free space to protect member PHI.
- • Travel up to 10% within Ohio to attend meetings, trainings, and site visits as required.
- • Collaborate with cross-functional teams to align quality improvement activities with organizational goals and regulatory standards.
- • Monitor and evaluate the effectiveness of implemented interventions and adjust strategies based on ongoing performance metrics.
🎯 Requirements
- • Must reside in the state of Ohio
- • Unrestricted Registered Nurse in Ohio OR Physician’s Assistant OR Master’s degree in health services, public health, or healthcare administration OR Certified Professional in Health Care Quality (CPHQ) OR Certified Health Care Quality Management (CHCQM)
- • At least 3 years of experience in delivering EPSDT services or healthcare quality improvement
- • Prior experience in a fast-paced insurance or healthcare setting
- • Knowledge of EPSDT and Child Health Services
- • Knowledge of Maternal and Pregnancy-related services
- • Understanding of healthcare quality measures (e.g., HEDIS)
- • Advanced Excel experience (pivot tables, charts, formulas)
- • 10% travel within Ohio
🏖️ Benefits
- • Medical, dental, and vision benefits
- • 401(k) retirement savings plan
- • Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- • Short-term and long-term disability insurance
- • Life insurance
- • Bonus incentive plan based on company and/or individual performance
- • Bi-weekly internet expense stipend for employees in California, Illinois, Montana, or South Dakota
- • Provision of telephone equipment for remote work
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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