Aetna Prevention & Wellness Coordina in Chicago, Illinois
Req ID: 42870BR
Participates in the development and ongoing implementation of Quality Management (QM)Work Plan activities and interventions to improve member quality of care outcomes. Measure and analyze data to work collaboratively with cross-departmental teams to meet and exceed QM HEDIS objectives to close member gaps in care. This position is responsible for coordinating prevention and wellness activities specifically designed to promote members timely access to preventive and well care through targeted member and 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, closing HEDIS gaps in care, and recommending options for improving performance.
Under the direction of the Director/Manager, develops, implements and assures ongoing coordination of designated preventive and well care activities outlined within the Quality Improvement Plan and Prevention and Wellness Work Plan, including assessments on enrollee participation and program impact. .
Assists Director/ Manager in strategies for readying the Plan's Prevention and Wellness initiatives and goals.
Researches annually the Plans clinical guidelines which include: EPSDT, preventive health guidelines, anticipatory guidance updates and clinical guidelines, and is responsible for disseminating updated guidelines through approval process and posting of outcomes to the Plan.
Works collaboratively with cross-departmental teams using HEDIS measures to develop and execute HEDIS interventions based on drivers to close member gaps in care.
Organizes pilot HEDIS interventions to target specific population initiatives; supports the HEDIS work groups (cross-departmental teams) to develop and execute interventions.
Attends HEDIS conferences, Illinois QM staff meetings, cross-departmental oversight committee meetings such as QM/UM, and other professional organizational meetings to support and promote the Plans objectives.
Applies the DMAIC Model to intervention development , execution, and recording outcomes : Define, Measure, Analyze, Improve, and Control, , record outcomes.
Develops member and provider collaterals, e.g., EPSDT and Well Women and Prenatal.
Assists Director/Manager as necessary in meeting Prevention and Wellness budget and is also responsible for outlining cost analysis.
Assists with the production of member newsletters to our member population and with provider newsletters.
Works with the Plans Community Outreach team to organize health education events for the Plans members.
Ability to articulate ideas and concepts clearly and effectively in writing and verbally.
Ability to speak appropriately to horizontal and vertical audiences both internal and external to the Plan.
Ability to lead a project.
Ability to summarize information quickly and easily.
HEDIS experience preferred, but not required.
Must work in the Chicago office
Ability to articulate ideas and concepts clearly and effectively in writing and verbally; ability to summarize information quickly and easily.
Managed care experience, working in an MCO, health insurance, providers office, or community health.
Ability to motivate groups of members to reach health management and well care targets.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Desktop Tools/Microsoft Outlook/1-3 Years
Desktop Tools/Microsoft PowerPoint/4-6 Years
Desktop Tools/Microsoft Word/4-6 Years
Desktop Tools/TE Microsoft Excel/4-6 Years
Benefits Management/Encouraging Wellness and Prevention/FOUNDATION
General Business/Communicating for Impact/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
General Business/Turning Data into Information/ADVANCED
Leadership/Collaborating for Results/ADVANCED
ADDITIONAL JOB INFORMATION
This role is for an individual who is motivated by improving the health and wellness of an underserved population, who likes educating both members and providers, and who works well in team settings. This role offers the opportunity to hold greater responsibility and lead projects that are increasingly complex over time with experience and proof of outcomes.
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 candidate'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.
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