HEDIS Prevention and Wellness CoordinatorPrimary Location: Charleston, WV
Additional Locations: WV-Charleston Apply
- 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.
- 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.
- 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.)
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