Facilitates provider and member outreach to ensure member receipt of important clinical services to improvement 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
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.
Strong communication skills and experience speaking with medical providers; Required
3+ years' recent and related health care marketing, outreach and/or health education experience; Required
Ability to work independently; Required
Ability to use standard corporate software packages and corporate applications; Required
Recent and related experience working with HEDIS criteria; Preferred
Experience working in call center environment; Preferred
The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe.
We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail.
Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.