HEDIS Coordinator - intiGrow

Reliable & Cost Efficient Recruitment Agency Based On Los Angeles

Contract

HEDIS Coordinator

Aetna, New Jersey

Description:

Qualification Rating
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)