, Texas

Job 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.

Required Qualifications
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.

Preferred Qualifications
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
Bachelor's degree or equivalent experience.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

, Texas

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