Description:

• 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:

• Ability to use standard corporate software packages and corporate applications.
• Strong communication skills and experience speaking with medical providers.
• Recent and related experience working with HEDIS criteria.
• Ability to work independently.Experience working in call center environment.
• Minimum 3 years' recent and related health care marketing, outreach and/or health education experience.
• Bachelor's degree or equivalent experience.

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

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)