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Health Care QM Project Manager - PA Medicaid Health Plan

Primary Location: Erie, Pennsylvania
Additional Locations: PA-Erie

Aetna Better Health of PA is hiring a Health Care QM Project Manager to support our growing Medicaid Health Plan!

This position is Work From Home Full Time, with the requirement that the employee reside in PA to cover the specific assigned territory in the Northwest part of the state. The position will be responsible for the following counties: Erie, Warren, Forest, McKean, Elk, Cameron, and Potter Counties.

Territories will be assigned based on a candidate's location and business need. This position will be in the field traveling 75-100% of the time. Reliable transportation and drivers license are required.

Our Health Care QM Project Manager will have the ability to successfully manage a number of providers and provide in person education to improve HEDIS and specific performance measure rates. Knowledge of medical record documentation, HEDIS, coding and outpatient services.

Fundamental Components:

Conduct onsite visits to provider offices in Pennsylvania to provide education on closing gaps that lead to improved HEDIS
rates. Provides an opportunity to manage daily schedule to meet established HEDIS goals. Excellent opportunity to influence practices that result in improved outcomes for members with Medicaid insurance. While part of a robust Quality Management team, the candidate will have the ability to work independently with the full support of peers and management.

Background Experience:

3+ years of experience in healthcare or managed care quality management; Required

Project management experience.

HEDIS and/or coding knowledge.

RN or LPN required.

Independent worker with ability to telecommute and travel at least 75% of the time in areas assigned within Pennsylvania.

Experience communicating with physicians, other providers and office staff.

Additional Job Information:

Required Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs

Functional Skills:
Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Quality management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
75 - 100%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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