Job Title

Job DescriptionFacilitates 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 included but are not limited to: 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.Required Qualifications3 years in HealthcareProficient in ExcelHas experience maintaining sharepointCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsWorked in Medicaid MCOEducationBachelors degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.