Job Description
Job Description
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs.?Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
Position Summary
The Health Survey Specialist plays a critical role within the DSNP team. The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the members Individualized Care Plan and sets the foundation for follow up care management by assessing a members medical, functional, cognitive, psychosocial, and mental health needs.
Fundamental Components
Uses motivational interviewing and other consultative techniques to gather comprehensive information about a members medical, functional, cognitive, psychosocial, and mental health needs
Accountable to the highest level of compliance integrity
Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNPs interdisciplinary care team and customer service
Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment
Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment
Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate
Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed
Accurately and consistently documents each call in the members electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements
Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA
Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm
Determined to build strong relationships with peers and our DSNP members
Demonstrates an outgoing, enthusiastic, and caring presence over the telephone
Required Qualifications
At least 3 years of experience in health care, customer service, telemarketing and/or sales
Familiarity with basic medical terminology, health care, and the concepts of care management
Medicare/Medicaid/DSNP experience preferred
Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required
Strong organizational skills, including effective verbal and written communications skills required
Data entry and documentation within member records is strongly preferred
Flexibility with work schedule to meet business needs
Bilingual Spanish preferred
Preferred Qualifications
Please see requirements above
Education
High School diploma or G.E.D. required
Associates/Bachelors degree preferred
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.
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs.?Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
Position Summary
The Health Survey Specialist plays a critical role within the DSNP team. The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the members Individualized Care Plan and sets the foundation for follow up care management by assessing a members medical, functional, cognitive, psychosocial, and mental health needs.
Fundamental Components
Uses motivational interviewing and other consultative techniques to gather comprehensive information about a members medical, functional, cognitive, psychosocial, and mental health needs
Accountable to the highest level of compliance integrity
Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNPs interdisciplinary care team and customer service
Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment
Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment
Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate
Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed
Accurately and consistently documents each call in the members electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements
Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA
Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm
Determined to build strong relationships with peers and our DSNP members
Demonstrates an outgoing, enthusiastic, and caring presence over the telephone
Required Qualifications
At least 3 years of experience in health care, customer service, telemarketing and/or sales
Familiarity with basic medical terminology, health care, and the concepts of care management
Medicare/Medicaid/DSNP experience preferred
Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required
Strong organizational skills, including effective verbal and written communications skills required
Data entry and documentation within member records is strongly preferred
Flexibility with work schedule to meet business needs
Bilingual Spanish preferred
Preferred Qualifications
Please see requirements above
Education
High School diploma or G.E.D. required
Associates/Bachelors degree preferred
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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