Job Description

Job Description
Participates in the development and ongoing implementation of QM Work Plan activities. Improves quality products and services by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives. This position is responsible for coordinating the Plan's prevention and wellness activities specifically designed to promote the importance and benefits of accessing timely preventive and well care through targeted member/provider education and outreach initiatives. Additionally, this position may include community outreach and public relations initiatives as assigned. This position is responsible for monitoring the Plan's overall performance against state and federal standards for health education and preventive care and recommending options for improving performance.Under the direction of the Director/Manager of Quality, develops the annual Prevention and Wellness Plan, including assessments on enrollee participation and program impact.Develops, implements and assures ongoing coordination of designated prevention/wellness activities outlined within the quality improvement plan and Prevention and Wellness work plan.Assists Manager in strategies for readying (the Plans) Prevention and Wellness initiatives and goals.Researches annually the plans clinical guidelines.Provides HEDIS interventions for Plan based on driver recommendations that include the P&W; outreach calendar and HEDIS measures.Supports HEDIS groups and subgroups providing assistance in developing interventions for specific departments.Organizes special or pilot HEDIS interventions to target specific population initiativesAttends HEDIS conferences, SA staff meetings and other professional organizational meetings to support and promote plans objectives.Evaluates, analyzes, reports on and records outcomes of scheduled P&W; interventionsDevelops mailing deliverables which include: EPSDT, Well Women and PrenatalAssists Director/Manager as necessary in meeting Prevention and Wellness budget and is also responsible for outlining cost analysis and appropriate collaterals.Assists with the production of quarterly member newsletters, submitting HEDIS articles and Assists with the production of quarterly scheduled provider newsletters.Produces and distributes quarterly community Partnerships in Health newsletters.Attends as necessary Quality Department meetings that include QM/UM, SIC, to provide P&W; updatesProvides necessary updates as needed and supporting documents for state RFP, NCQA and EQRA reviews and proposal submissions.Ensures mandatory RFP outcomes regarding quarterly EPSDT updatesDevelops and maintains HEDIS Prevention and Wellness calendar and organizes member health educational events.Coordinates efforts with SAI to develop written communication materials.Updates routine member communications.Serves as health plan resource for activities concerning state or federal programs for targeted preventive services.Functions as a liaison for the health plans approved projects/programs related to outreach efforts.Collaborates with various health management team members to develop specific interventions.Maintains resource library of educational programs and develop materials and tool for specific sponsored programs.Serves as corporate and local resource for reviewing member communication materials as assigned or required.Collaborates with appropriate DPCI departments to organize outreach projects as determined by manager. Develops educational materials for members, may assist with in-service or education of providersUpdates desktops policies and procedures as related to prevention and wellness objectives.Assist in conducting telephonic follow-up to members.Promotes utilization of EPSDT, immunization and dental services through parent/member, community contact providing resources.Participates in educational presentations, workshops, seminars, community events and school programs sponsored by Plan.Provides support to organize and conduct member and provider interventions via mailing, telephone and other modalities as required.Assists in meeting the Plans requirements and standards for Regulatory and other accrediting agencies.Provides support and functions as a liaison for Plans approved programs.Assists in the development and utilizes educational programs sponsored by plan, equity owner health systems, local health department and community advocacy groups.

Required Qualifications
- Effective communication/influencing skills applied to
broad internal/external audience.
- Minimum 3 years' recent and related health care
marketing, outreach and/or health education
experience.
- Bachelor degree in a health-related field (Health
Education, etc.)

Preferred Qualifications
- Minimum of one year of recent and related experience
working with local health departments, community agencies
or managed care organizations serving Medicaid recipients.
- 3 years experience in professional
communications.
- Managed care experience, as provider and manager of
care. Masters in Public Health preferred.

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.