HEDIS Coordinator - intiGrow

Reliable & Cost Efficient Recruitment Agency Based On Los Angeles

Contract

HEDIS Coordinator

Aetna, New Jersey

    Description:

    QualificationRating
    Must Have
    CVS Caremark Requirements
    Prior CVS/Aetna work experience?
    No
    Verifiable High School Diploma or GED Required
    Yes
    ALERT:
    This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by their start date (other date may be inserted if start date is not accurate), subject to approved medical or religious exemptions.
    Duties

    LOCATION: NJ – MUST travel within Northern NJ

    *MUST be able to read medical records when pulling files

    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 &
    Physical Requirements
    Additional Information
    (Fundamental Components)
    Background Experience
    Desired
    Education and Certification
    Requirements
    Additional Information
    Attachments
    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.
    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.

    Experience

    LOCATION: NJ – MUST travel within Northern NJ

    *MUST be able to read medical records when pulling files

    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 &
    Physical Requirements
    Additional Information
    (Fundamental Components)
    Background Experience
    Desired
    Education and Certification
    Requirements
    Additional Information
    Attachments
    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.
    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.

    Position Summary

    LOCATION: NJ – MUST travel within Northern NJ

    *MUST be able to read medical records when pulling files

    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 &
    Physical Requirements
    Additional Information
    (Fundamental Components)
    Background Experience
    Desired
    Education and Certification
    Requirements
    Additional Information
    Attachments
    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.
    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.

    Education
    High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience.
    What days & hours will the person work in this position? List training hours, if different.
    M-F 8-5
    Program Office – Point Of Contact
    Jennifer Sortor
    Is this an in-person, patient-facing role?
    No
    Onsite Requirements
    Fully remote (never coming onsite)