Aetna Outreach Coordinator, HEDIS in Moon township, Pennsylvania

Req ID: 52531BR

POSITION SUMMARY

A integral member of the Quality Management team; involved in efforts to improve members' access to care, and increased administrative capture of data, as measured by HEDIS and state-specific quality measures.

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 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:

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 required.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Quality Management/Quality Management/1-3 Years

Functional - Project Management/Evaluating success/lessons learned/4-6 Years

ADDITIONAL JOB INFORMATION

Join a diverse, yet cohesive team of people working to ensure that our healthcare members receive top quality from their healthcare benefits. Must be ready for both challenges and growth, along with ability for consistency of actions. Polite, professional, and patient personal characteristics are key for participation on this team.

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.

Job Function: Quality Management