Job Description
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
Position Summary
The Health Survey Specialist plays a critical role within the DSNP team. The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the member s Individualized Care Plan and sets the foundation for follow up care management by assessing a member s medical, functional, cognitive, psychosocial, and mental health needs.
Fundamental Components
- Uses motivational interviewing and other consultative techniques to gather comprehensive information about a member s medical, functional, cognitive, psychosocial, and mental health needs
- Accountable to the highest level of compliance integrity
- Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNP s interdisciplinary care team and customer service
- Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment
- Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment
- Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate
- Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed
- Accurately and consistently documents each call in the member s electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements
- Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA
- Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm
- Determined to build strong relationships with peers and our DSNP members
- Demonstrates an outgoing, enthusiastic, and caring presence over the telephone
Required Qualifications
- At least 3 years of experience in health care, customer service, telemarketing and/or sales
- Familiarity with basic medical terminology, health care, and the concepts of care management
- Medicare/Medicaid/DSNP experience preferred
- Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required
- Strong organizational skills, including effective verbal and written communications skills required
- Data entry and documentation within member records is strongly preferred
- Flexibility with work schedule to meet business needs
- Bilingual desired
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