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KS Medicaid HEDIS Manager

Primary Location: Overland Park, KS
Additional Locations: KS-Overland Park
Oversight of the HEDIS project, including management of the full HEDIS project. This includes development of the project, day-to-day management of HEDIS operations and HEDIS regular and temporary staff.

Fundamental Components:
Operational oversight of the full HEDIS project in compliance with NCQA, state and federal requirements. Manages key functions including development of population definition, medical record review and abstraction and use of supplemental data. Personnel management of HEDIS staff including ABHKS and temporary employees. On an ongoing basis, collaborates with the national HEDIS team to assure that plan HEDIS operations consider CVS organizational services and incorporates identified best practices. Conducts analysis of performance measures, researches and identifies opportunities for improvement and prioritizes HEDIS initiatives based on input from leadership. Reviews and provides gaps-in-care reports to providers and serves as a subject matter expert on these reports to internal ABHKS staff and external customers. Performs data analyses including data stratifications to target improvement of HEDIS performance results in support of strategic plans, Performance Improvement Projects, external audits and NCQA accreditation. Translates knowledge of subject and business needs into clear strategic business plans. Serves as a technical, professional and/or business expert that may cross multiple business functions.

Background Experience:
Must have experience in running a HEDIS project, including but not limited to, initial population definition, oversight of medical record review and abstraction, over-reads, identification of use of supplemental data sources (at least 2 full cycles);
Experience in managing staff; this position will manage ABHKS and temporary staff during the medical record project as well focus on member and provider outreach.
Experience in working with performance results and initiatives aimed at improving HEDIS scores.

Additional Job Information:
Preferred experience in gaps-in-care reporting and presentation of results to external customers. Understanding of local and national trends in HEDIS measurement and constituency expectations.

Required Skills:
General Business - Ensuring Project Discipline, General Business - Turning Data into Information

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results

Functional Skills:
Quality Management - Quality Management

Potential Telework Position:

Percent of Travel Required:
10 - 25%

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

Benefit Eligibility:
Benefit eligibility may vary by 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.

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