Director of Nursing - Pediatric EPSDT program

Job Description

Job Description:\n\nDescription:\nEPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment. At Inteli-Care, we are proud to support families by providing services that fall under EPSDT, including preventive care, screenings, and treatments designed to identify needs early and support the long-term wellness of Medicaid-eligible individuals under 21 years of age.\n\nWe are looking for an experienced, compassionate, and highly organized EPSDT Program Director of Nursing to provide clinical leadership and operational oversight for our EPSDT program.\n\nThe EPSDT Program Director of Nursing is responsible for ensuring the delivery of high-quality, compliant, patient-centered nursing services while providing leadership and clinical oversight to the EPSDT nursing team. This position will oversee clinical operations, nursing standards, staff performance, regulatory compliance, care coordination, documentation quality, and program outcomes.\n\nThe ideal candidate is a collaborative and accountable nursing leader who combines strong clinical judgment with the ability to develop people, improve processes, and maintain a culture centered on the needs of our Members and their families. You’ll be a perfect fit for our team if you are a caring and compassionate leader, take a patient-first approach, value collaborative and mission-driven work, and are committed to maintaining the highest standards of clinical quality and regulatory compliance.\n\nResponsibilities\nClinical Leadership & Program Oversight\n\n Provide overall clinical leadership and nursing oversight for the Inteli-Care EPSDT program.\n Establish, implement, and maintain nursing standards, clinical procedures, and best practices consistent with EPSDT program requirements and organizational policies.\n Ensure EPSDT Members receive appropriate, timely, and patient-centered nursing services.\n Provide clinical consultation and support to EPSDT Registered Nurses and other team members regarding Member needs, changes in condition, plans of care, and complex non-medical situations.\n Serve as a clinical escalation resource for EPSDT nursing staff.\n Promote consistent standards of care across all designated EPSDT service areas.\n Partner with operational leadership to ensure appropriate nursing coverage, caseload management, and continuity of services.\n Identify opportunities to strengthen clinical processes, improve Member outcomes, and enhance the overall quality of the EPSDT program.\n\nEPSDT Assessments & Member Care\n\n Ensure initial and supervisory nursing assessments are completed appropriately to identify the needs of EPSDT Members.\n Conduct or support initial, supervisory, or other nursing assessments when operationally necessary.\n Ensure applicable non-medical observations are appropriately documented during Member visits.\n Ensure required EPSDT visits are conducted and documented every 62 calendar days following the initial assessment, or more frequently when the condition of the Medical Assistance Division eligible recipient warrants additional oversight.\n Ensure nursing visits conducted at the Member’s residence appropriately assess the Member’s progress and the performance of the Personal Care Services attendant.\n Oversee the development, clinical review, and ongoing updating of the Individual Treatment Plan (ITP) in collaboration with the Member, family, nursing staff, and Managed Care Organization Care Coordinator.\n Ensure changes in Member condition, service needs, or risks are identified, communicated, documented, and addressed in a timely manner.\n Promote continuity of care and appropriate clinical follow-up for EPSDT Members.\n\nNursing Staff Leadership & Development\n\n Provide direct supervision, coaching, development, and performance management for EPSDT nursing staff.\n Participate in the recruitment, interviewing, selection, onboarding, and retention of qualified EPSDT nurses.\n Ensure newly hired nursing staff receive appropriate clinical orientation and training before independently performing assigned responsibilities.\n Assess nursing competencies and provide education, coaching, or corrective action when performance or compliance concerns are identified.\n Conduct regular team meetings, individual coaching sessions, and clinical case reviews as appropriate.\n Foster a supportive, accountable, collaborative, and patient-first nursing culture.\n Ensure nursing staff maintain all required licenses, certifications, credentials, training, and employment requirements.\n Identify educational needs and coordinate ongoing clinical education and professional development opportunities for nursing staff.\n Maintain appropriate nursing coverage and assist with contingency planning for staffing changes or Member needs.\n\nDocumentation & Regulatory Compliance\n\n Ensure all electronic and/or paper clinical documentation is completed accurately, timely, and in accordance with applicable requirements and the designated system of record.\n Monitor nursing documentation for completeness, accuracy, clinical quality, and compliance.\n Conduct routine documentation audits and implement corrective action plans when deficiencies or trends are identified.\n Ensure required EPSDT assessments, supervisory visits, ITP documentation, Member records, and nursing notes are completed within established timelines.\n Maintain familiarity with applicable EPSDT, Medicaid, Medical Assistance Division, Managed Care Organization, state, federal, and organizational requirements affecting program operations.\n Translate regulatory and payer requirements into clear nursing processes and staff expectations.\n Support organizational readiness for audits, reviews, surveys, or regulatory inquiries related to EPSDT nursing services.\n Participate in the development and ongoing review of clinical policies, procedures, workflows, and forms.\n Immediately escalate significant clinical, compliance, quality, or safety concerns to appropriate organizational leadership.\n\nQuality Assurance & Performance Improvement\n\n Develop and maintain a nursing quality assurance process for the EPSDT program.\n Monitor key clinical and operational indicators, including required visit completion, documentation timeliness, plan-of-care updates, Member concerns, incidents, and staff performance.\n Identify trends, gaps, and areas of clinical risk and develop appropriate corrective and preventive actions.\n Review incidents, complaints, Member concerns, and adverse events involving nursing services and ensure appropriate follow-up.\n Collaborate with organizational leadership on quality improvement initiatives and program performance goals.\n Promote evidence-informed non-medical practices and continuous improvement throughout the EPSDT nursing program.\n Track corrective actions through completion and evaluate their effectiveness.\n Support initiatives designed to improve Member satisfaction, quality outcomes, and continuity of care.\n\nCare Coordination & Communication\n\n Oversee coordination of care between EPSDT nursing staff, Members, families, Personal Care Attendants, Managed Care Organization Care Coordinators, and other prescribed individuals involved in the Member’s care.\n Maintain effective professional communication with Members, family members, healthcare providers, care coordinators, team members, and other healthcare professionals.\n Facilitate resolution of clinical or service-related concerns that require nursing leadership involvement.\n Support nursing staff in obtaining necessary non-medical information, provider orders, Individual Treatment Plan updates, or other information needed to safely coordinate Member services.\n Build collaborative relationships with internal departments and external healthcare partners.\n Represent the nursing function in interdisciplinary meetings, leadership discussions, and EPSDT program planning.\n\nMember & Employee Orientation\n\n Oversee nursing responsibilities related to New Employee Orientation (NEO) and New Member Orientation (NMO).\n Ensure required orientation paperwork is delivered, reviewed, completed, and documented appropriately by Members and Personal Care Attendants.\n Ensure appropriate identification of a Legally Responsible Individual (LRI) and completion of required LRI documentation.\n Ensure nurses understand their responsibilities regarding orientation, Member education, documentation, and follow-up.\n\nProgram Administration\n\n Partner with EPSDT and organizational leadership to establish program priorities, goals, staffing needs, and quality objectives.\n Develop and maintain workflows that promote timely assessments, supervisory visits, care-plan updates, and documentation completion.\n Assist with managing nursing assignments and workloads based on Member acuity, geographic coverage, staffing capacity, and program priorities.\n Provide leadership with regular updates regarding clinical operations, staffing, compliance, risks, and program performance.\n Participate in planning for program growth and ensure nursing infrastructure appropriately supports expansion.\n Collaborate with leadership to identify resource, training, technology, and process needs affecting nursing operations.\n Perform additional clinical leadership responsibilities as needed to support the EPSDT program and Inteli-Care Members.\n\nDesignated Service Areas\nDesignated service areas may include:\n\n Bernalillo County\n Sandoval County\n Santa Fe County\n Socorro County\n Torrance County\n Valencia County\n San Juan County\n\nTravel throughout designated service areas may be required based on Member and program needs.\nRequirements:\n\n Graduate of an accredited Diploma, Associate, or Bachelor’s School of Nursing.\n Current, unrestricted New Mexico Registered Nurse license.\n Current CPR certification.\n Minimum of three years of direct patient care nursing experience, preferably involving pediatric, home health, community-based, Medicaid, or similar populations.\n Minimum of two years of nursing leadership, supervisory, clinical management, or comparable experience preferred.\n Strong clinical assessment and nursing judgment skills.\n Demonstrated ability to supervise, coach, and hold clinical staff accountable to performance and documentation standards.\n Strong understanding of nursing documentation, care coordination, clinical quality, and regulatory compliance.\n Excellent written and verbal communication skills.\n Excellent interpersonal, leadership, organizational, and problem-solving skills.\n Ability to communicate effectively with Members, families, physicians, care coordinators, nursing staff, Personal Care Attendants, and other healthcare professionals.\n Ability to operate effectively under stressful conditions, prioritize competing responsibilities, and make sound clinical decisions.\n Compassionate and professional demeanor with a strong commitment to patient-centered care.\n Ability to maintain confidentiality and exercise appropriate professional judgment.\n Negative TB test as required.\n Maintain required insurance.\n Dependable transportation and willingness to travel to Member residences and other locations within designated service areas.\n Ability to use electronic clinical documentation systems and other technology necessary to manage program responsibilities.\n\nPreferred Qualifications\n\n Bachelor of Science in Nursing (BSN) preferred.\n Experience with EPSDT services strongly preferred.\n Experience working with Medicaid-funded programs and/or Managed Care Organizations preferred.\n Experience in home- and community-based services, pediatric nursing, personal care services, home health, or similar programs preferred.\n Experience conducting clinical audits, quality assurance activities, or performance improvement initiatives preferred.\n Experience developing clinical policies, workflows, training, or competency programs preferred.\n Fluent in Spanish\n\nPhysical Requirements\n\n Ability to stand or walk for prolonged periods as required.\n Hand-eye coordination and manual dexterity necessary to perform nursing responsibilities.\n Ability to lift up to 50 pounds and assist with Member movement when clinically necessary.\n Ability to safely travel to Member residences and other work locations.\n Ability to perform duties in a variety of home and community environments.\n\nLeadership Competencies\n\n Patient-First Leadership – Keeps the health, safety, dignity, and individual needs of Members at the center of decision-making.\n Clinical Excellence – Maintains high standards for assessment, documentation, care planning, and nursing practice.\n Accountability – Establishes clear expectations and follows through on commitments, performance standards, and corrective actions.\n Collaboration – Works effectively across departments and with Members, families, providers, MCOs, and community partners.\n Communication – Communicates expectations, concerns, changes, and clinical information clearly and professionally.\n Problem Solving – Identifies root causes, evaluates options, and implements practical solutions.\n Continuous Improvement – Looks for opportunities to strengthen processes, quality, compliance, and Member outcomes.\n Staff Development – Coaches and develops nurses while creating an environment that supports learning and professional growth.\n Integrity – Demonstrates sound judgment, professionalism, confidentiality, and ethical leadership.\n\nWe Support You By\n\n Being Flexible – We aim to create an environment that recognizes the importance of balancing professional and personal priorities.\n Offering Education and Learning Opportunities – Certifications, courses, and professional development opportunities to support continued growth.\n Providing opportunities to lead meaningful clinical and quality initiatives.\n Supporting collaboration across clinical, operational, and leadership teams.\n Offering applicable Inteli-Care benefits based on position and employment status.\n\nOur Commitment\nAt Inteli-Care, our EPSDT program exists to help Members receive the support, care, and oversight they need to thrive. The EPSDT Program Director of Nursing plays a critical role in ensuring that our nursing services remain compassionate, compliant, consistent, and centered on the unique needs of each Member and family.