Job Description
Job Description
-Facilitates provider and member outreach to ensure member receipt of important clinical services to improve member health outcomes.
-Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
-Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
-Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
-Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.
-Identifies when to refer member to Social Worker or Case Manager.
-Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
-Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
-Documents member participation in outreach activities in accordance with abstraction and audit standards.
-Conducts HEDIS provider chart request calls and mailings.
-May develop and maintain member incentive programs to support HEDIS initiatives.
-Maintains incentive database to track member compliance.
-May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events).
-Works with internal staff to schedule, organize, and staff these events.
-Records and documents all member and provider outreach activity.
-Performs other duties as required.
Required Qualifications
-Minimum 3 years' recent and related health care marketing, outreach and/or health education experience.
-Recent and related experience working with HEDIS criteria
-Experience working in call center environment
-Strong communication skills and experience speaking with medical providers.
-Ability to work independently.
-Ability to use standard corporate software packages and corporate applications.
Preferred Qualifications
Please review required qualifications above
Education
Associate's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
-Facilitates provider and member outreach to ensure member receipt of important clinical services to improve member health outcomes.
-Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
-Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
-Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
-Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.
-Identifies when to refer member to Social Worker or Case Manager.
-Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
-Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
-Documents member participation in outreach activities in accordance with abstraction and audit standards.
-Conducts HEDIS provider chart request calls and mailings.
-May develop and maintain member incentive programs to support HEDIS initiatives.
-Maintains incentive database to track member compliance.
-May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events).
-Works with internal staff to schedule, organize, and staff these events.
-Records and documents all member and provider outreach activity.
-Performs other duties as required.
Required Qualifications
-Minimum 3 years' recent and related health care marketing, outreach and/or health education experience.
-Recent and related experience working with HEDIS criteria
-Experience working in call center environment
-Strong communication skills and experience speaking with medical providers.
-Ability to work independently.
-Ability to use standard corporate software packages and corporate applications.
Preferred Qualifications
Please review required qualifications above
Education
Associate's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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