Job Title

Job DescriptionThe Health Advocate within the Healthy Outcomes Team conducts outreaches to our Medicare members to inspire and encourage healthy behaviors through innovative, compassionate and empathetic telephonic communications. The goal of each outreach is to ensure that every member has a clear understanding of the available benefits that are afforded to them under their Medicare plan for specific screenings and medications. The Health Advocate facilitates Provider and Member outreaches telephonically to ensure Medicare member receipt of important services to improve Star health outcomes. The Health Advocate provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives by performing the following: Outreach to members who don't have a record of the designated services, vaccination, or medication refill. Effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions to meet the gap in care, and providing best in class support to each member. Ensures that every customer is treated professionally, with respect and all questions are thoroughly answered and/or triaged and responded to. Acts as an advocate for our Medicare members preventive health and vaccination needs. Collect effective data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation and services. Provides members with the right information at the right time to help them make better decisions about their health and health care, to increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Engages, consults, and educates members based upon the member's unique needs, preferences and understanding of the services. Provides end to end accountability for the member. Answers questions and resolves issues as a "single-point-of-contact" Builds a trusting relationship with the member by taking accountability to fully understand the member's needs. Walk members through programs, Aetna tools and resources to support better health care consumer behaviors. Takes ownership of each member contact to resolve their issues and connect them with additional services as appropriate. Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes. Uses communication skills to build relationships with both internal and external members/constituents. Uses applicable system tools and resources to produce and/or quality letters and spreadsheets in response to inquiries received. Handle multiple functions and/or multiple products while maintaining and/or exceeding performance standards. Identifies issues that need to be escalated appropriately and offers suggestions for resolution. Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents. Supports individual, team and business goals and initiatives; accepts ownership for individual results.Required Qualifications6+Months of Customer Service Call CenterWindows based application knowledge with ability to use standard corporate software packages and corporate applications with a high degree of computer literacy. Effective communication skills and experience speaking with medical providers and/or clinical staff. Strong listening and interpersonal skills; skilled at developing and maintaining effective working relationships. Strong analytical skills focusing on accuracy and attention to detail. Demonstrated ability to de-escalate situations. Demonstrated empathy, compassion and listening skills. Ability to apply creative thinking skills when needed to solve members' concerns and have a desire to advocate for them. Ability to thrive on change, to adapt to multiple focuses in short amounts of time. Ability to work independently, apply critical thinking skills when needed, multitask with ease, and demonstrate professionalism in all interactions. Ability to resolve complex issues with sensitivity and discretion. Ability to creatively solve members' problems and have desire to help and advocate for them. Ability to absorb and apply new and changing information. Ability to make effective and independent decisions Ability to multitask, prioritize and effectively adapt to a fast-paced changing environmentCOVID 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 QualificationsRecent and related experience working with HEDIS screening measures and/disease management, behavior change. Bilingual or multilingual candidates heavily preferred. Bachelor's degree or equivalent heavily preferred. Medical certification (certified nursing assistant, medical assistant, etc.) is strongly recommended but not required. Prior experience working directly with members / consumers - preferably in a call center setting. Minimum 3 years recent and related experience within healthcare, healthcare marketing, outreach and/or health education, health coaching and disease management experience required. 3 - 5 years of experience in a healthcare setting with direct communication with various levels of management including medical providers required.EducationHigh School Diploma or G.E.D.Business 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.