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Outreach Cordinator, HEDIS

Primary Location: Walnut Creek, California
Additional Locations: CA-Fresno, CA-Los Angeles, CA-Menlo Park, CA-Sacramento, CA-San Francisco, CA-Walnut Creek

Aetna is searching for a HEDIS Quality Outreach Coordinator to perform HEDIS data collection and HEDIS quality improvement activities including medical record pursuit, abstraction and data entry of HEDIS measure data in compliance with HEDIS technical specifications, comprehensive analyses of HEDIS results, identify opportunities for HEDIS improvement and assist in designing and implementing quality improvement activities to increase HEDIS rates.

Fundamental Components:
  • Perform HEDIS data collection and HEDIS quality improvement activities including medical record pursuit, claims research, and abstraction and data entry of HEDIS measure data in compliance with HEDIS technical specifications.
  • Ensure compliance with all NCQA HEDIS technical specifications, Aetna policies, operating procedures, and goals in compliance with internal and external guidelines.
  • Assist in developing annual HEDIS project plans, monitor project progress, and ensure all project deadlines are met.
  • Provide comprehensive analysis of HEDIS results, barriers, and identify opportunities for quality improvement across Aetna’s markets.
  • Conduct quality improvement activities to increase HEDIS rates across Aetna's markets including outreach to providers, medical groups, hospitals and members to discuss HEDIS results and quality improvement activities.
  • Monitor effectiveness of quality improvement activities and implement modifications as needed to improve HEDIS performance across Aetna’s markets.
  • Collaborate with cross functional departments to design, implement and monitor effectiveness of quality improvement activities to increase HEDIS rates across Aetna’s markets.
  • Serve as a HEDIS subject matter expert for internal and external constituents.

Background Experience:
  • MINIMUM of 1+ years of HEDIS data collection and HEDIS quality improvement experience in the healthcare industry
  • 1 to 3 years managed care experience in the healthcare industry or quality management.
  • Ability to work independently and achieve results while teleworking.
  • Experience working with health care providers and health plan members.
  • Ability to manage multiple, complex projects with strict deadlines.

Additional Job Information:
This is an exceptional opportunity to do meaningful work to build a healthier world by improving the quality of health care for those that we serve at one of America's leading health benefits companies. 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 offers a competitive salary and a generous benefits package. 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.

Required Skills:
Benefits Management - Maximizing Healthcare Quality, General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results

Desired Skills:
General Business - Maximizing Work Practices, Service - Improving Constituent-Focused Processes, Technology - Leveraging Technology

Functional Skills:
Clinical / Medical - Quality management

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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