Aetna CA Outreach Coord, HEDIS in W. Sacramento, California

Req ID: 45070BR

POSITION SUMMARY

Positions may be based in Sacramento and San Diego. 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.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE desired:

Education and Certification Requirements

Bachelor's degree or equivalent experience.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Communications/Member communications/1-3 Years

Functional - Communications/Provider communications/1-3 Years

Functional - Customer Service/Customer Service - Outbound calls - survey administration/1-3 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/1-3 Years

Functional - Administration / Operations/Document production & distribution/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User

ADDITIONAL JOB INFORMATION

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. Proficiency with MS Office Suite applications and strong keyboard navigation skills is required.

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.

Job Function: Quality Management