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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Outreach Coordinator, HEDIS

Primary Location: Rockville, MD
Additional Locations: MD-Rockville
  • Develop relationships with providers that are beyond mailing providers gap in care lists and requesting they send in the medical records.
  • Partnering with providers to evaluate their current quality of care, identify gaps in care, and opportunities for improvement, and partner to bring forth initiatives and new processes that ultimately will result in our members receiving the prevention services and the treatment services that they need in order to realize their best health.
  • 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.

Required Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact

Desired Skills:
General Business - Consulting for Solutions, Technology - Leveraging Technology

Functional Skills:
Clinical / Medical - Clinical claim review & coding, Customer Service - Customer service - Medical billing, Customer Service - Customer Service - Member Services - Traditional products

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
50 - 75%

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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