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Job Information

Aetna (HEDIS) Quality Management Sr. Consultant - PA Medicaid Health Plan in West Chester, Pennsylvania

Req ID: 64022BR

Job Description

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 included but are not limited to:

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.

Qualifications Requirements and Preferences:

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

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

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

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.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Quality Management

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.