Candidate must be able to work in the surrounding Charleston, WV area
Participates in the development and ongoing implementation of QM HEDIS Work Plan activities. Participates in the annual HEDIS Medical Record Review Project. Improves quality products and services by using measurement and analysis to process, evaluate and make recommendations to meet QM HEDIS objectives. This position is responsible for coordinating the Plan's HEDIS prevention and wellness activities specifically designed to promote the importance and benefits of accessing timely preventive and well care through targeted member/provider education and outreach initiatives. Additionally, this position may include community outreach and public relations initiatives as assigned. This position is responsible for monitoring the Plan's overall performance against state and federal standards for health education and preventive care and recommending options for improving performance.
Under the direction of the Director/Manager of Quality, develops the annual Prevention and Wellness Plan, including assessments on enrollee participation and program impact.
Develops, implements and assures ongoing coordination of designated prevention/wellness activities outlined within the HEDIS quality improvement plan.
Assists Manager in strategies for readying (the Plan's) Prevention and Wellness initiatives and goals.
Researches annually the plan's clinical guidelines.
Provides HEDIS interventions for Plan based on driver recommendations that include the P&W outreach calendar and HEDIS measures.
Supports HEDIS groups and subgroups providing assistance in developing interventions for specific departments.
Organizes special or pilot HEDIS interventions to target specific population initiatives.
Attends HEDIS conferences, staff meetings and other professional organizational meetings to support and promote plan's HEDIS objectives.
Evaluates, analyzes, reports on and records outcomes of scheduled P&W interventions.
Develops mailing deliverables which may include but not be limited to: EPSDT, Well Women and Prenatal. Assists Director/Manager as necessary in meeting Prevention and Wellness budget and is also responsible for outlining cost analysis and appropriate collaterals.
Assists with the production of member newsletter articles.
Assists with the production of provider HEDIS educational materials.
Attends as necessary Quality Department meetings that may include QM/UM, SIC, to provide P&W updates.
Provides necessary updates as needed and supporting documents for state RFP, NCQA and EQRO reviews and proposal submissions.
Ensures mandatory RFP outcomes regarding quarterly EPSDT.
Updates, develops and maintains HEDIS Prevention and Wellness calendar and organizes member health educational events.
Serves as health plan resource for activities concerning state or federal programs for targeted preventive services.
Functions as a liaison for the health plan's approved projects/programs related to HEDIS outreach efforts.
Collaborates with various health management team members to develop specific HEDIS interventions.
Maintains resource library of educational programs and develops materials and tools for specific sponsored programs.
Develops educational materials for members, may assist with in-service or education of providers.
Updates desktops policies and procedures as related to prevention and wellness objectives.
Assist in conducting telephonic follow-up to members.
Promotes utilization of, but not limited to, EPSDT, immunization and dental services through parent/member, community contact providing resources.
Participates in educational presentations, workshops, seminars, community events and school programs sponsored by Plan.
Provides support to organize and conduct member and provider interventions via mailing, telephone and other modalities as required.
Assists in meeting the Plan's requirements and standards for Regulatory and other accrediting agencies.
Provides support and functions as a liaison for Plans approved HEDIS programs.
Effective verbal and written communication/influencing skills applied to broad internal/external audience.
Minimum 3 years' recent and related health care marketing, outreach and/or health education experience.
Minimum of one year of recent and related experience working with local health departments, community agencies or managed care organizations serving Medicaid recipients.
Bachelor degree in a health-related field (Health Education, etc.)
Additional Job Information
This position offers a unique opportunity to join the Aetna Better Health of WV Quality Management HEDIS team in support of all accreditation and regulatory compliance activities.
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
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.