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(HEDIS) Quality Management Sr. Consultant - PA Medicaid Health Plan

Primary Location: Allentown, PA
Additional Locations: PA-Allentown, PA-Avondale, PA-Bellefonte, PA-Bethlehem, PA-Blue Bell, PA-Bristol, PA-Bucks, PA-Carlisle, PA-Chambersburg, PA-Chester, PA-Clearfield, PA-Coatesville, PA-Croydon, PA-Danville, PA-Doylestown, PA-Drexel Hill, PA-Easton, PA-Gettysburg, PA-Harrisburg, PA-Lancaster, PA-Lebanon, PA-Levittown, PA-Lewisburg, PA-Malvern, PA-Media, PA-Montgomery, PA-Norristown, PA-Oxford, PA-Plymouth Meeting, PA-Pottsville, PA-Reading, PA-Spring City, PA-Sunbury, PA-West Chester, PA-Wilkes-Barre, PA-Williamsport, PA-York

Aetna Better Health of PA is hiring 5 Quality Management Senior Consultants to support our growing Medicaid Health Plan!

These 5 positions are Work From Home Full Time, with the requirement that the employee reside in PA to cover specific assigned territories

Territories will be assigned based on a candidates 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 Quality Management Senior Consultants 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 and perform review of medical records. Participate in the annual HEDIS medical record review and perform all additional education as needed to ensure providers are aware of the plan's improvement needs. 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 experience in healthcare or managed care quality management; required

Project management experience; preferred

HEDIS and/or coding knowledge; strongly preferred

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

Experience communicating with physicians, other providers and office staff; required
RN or LPN; required

Additional Job Information:
Strengths must include excellent communication skills, ability to work independently, and willingness to perform in accordance to needs of the plan and provider network, including working later in the day to accommodate provider office needs.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, General Business - Communicating for Impact

Desired Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Promoting Health Information Technology, Benefits Management - Understanding Clinical Impacts

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

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.

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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