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HEDIS Prevention and Wellness Coordinator

Primary Location: Charleston, WV
Additional Locations: WV-Charleston
  • Participates in the development and ongoing implementation of QM HEDIS Work Plan activities.
  • 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 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.

Fundamental Components:
  • 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 quality improvement plan and Prevention and Wellness work 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, SA staff meetings and other professional organizational meetings to support and promote plan’s objectives.
  • Evaluates, analyzes, reports on and records outcomes of scheduled P&W interventions.
  • Develops mailing deliverables which include but are not 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 quarterly member newsletters, submitting HEDIS articles and assists with the production of quarterly scheduled provider newsletters.
  • Attends as necessary Quality Department meetings that 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.
  • Coordinates efforts with SAI to develop written communication materials.
  • Updates routine member communications.
  • 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 outreach efforts.
  • Collaborates with various health management team members to develop specific interventions.
  • Maintains resource library of educational programs and develop materials and tools for specific sponsored programs.
  • Serves as corporate and local resource for reviewing member communication materials as assigned or required.
  • Collaborates with appropriate DPCI departments to organize outreach projects as determined by manager.
  • 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 EPSDT, immunization, dental and other various 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 Plan's approved programs.
  • Assists in the development and utilizes educational programs sponsored by plan, equity owner health systems, local health department and community advocacy groups.

Background Experience:
  • 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.

Required Skills:
Benefits Management - Encouraging Wellness and Prevention, General Business - Ensuring Project Discipline, General Business - Turning Data into Information

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results

Functional Skills:
Quality Management - Quality Management

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)


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