Aetna KS Medicaid HEDIS Manager (51953BR) in Overland Park, Kansas

Req ID: 51953BR


Implements an all product quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes. Using innovation, integration, and information links the quality management activities to business goals. Health Care Quality Management includes, but is not limited to, HEDIS, QM Programs/Infrastructure, behavioral health QM, credentialing, delegation and regulatory accreditation support, clinical and service measurement and improvement and quality of care investigations.

Accountable for HEDIS health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links the quality management activities to business goals. Proactively builds strong teams and business relationships, both internally and externally. Serves as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.

Fundamental Components:

Makes business decisions based on the results of research and data analysis.

Has responsibility for decision making regarding the design, development, and implementation strategy of HEDIS quality improvement projects, and initiatives.

May manage a QM functional department including development and oversight of HEDIS performance metrics and application of HR policies and procedures.

Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans.

Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers.

Partners with sales and marketing across all segments in their efforts to acquire and retain customers (e.g. responding to RFPs), quality presentations, request for measurement information.

Develops and implements the infrastructure of the QM program and Patient Safety strategy.

Develops, implements, and evaluates the HEDIS organizations policies and procedures to meet business needs.

Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization.

Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives.

Provides comprehensive analysis of HEDIS measures, barriers and opportunities and present results of improvement efforts and ongoing performance measures to management.

Manages all clinical quality metrics, HEDIS processes and results

In partnership with business owners, supports design /development of new or enhanced products and services.

Translates knowledge of HEDIS and business needs into clear strategic business plans.

Serves as a technical, professional and/or business expert that may cross multiple business functions.


6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management.

Previous HEDIS experience; computer literate with advanced proficiency in MS Office Suite applications and keyboard navigation skills.

Demonstrated leadership ability.

Education and Certification Requirements:

Bachelor's degree, Nursing degree, or other comparable healthcare experience.

Additional Information:

Understanding of trends and constituency expectations.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Nursing/Registered Nurse (RN) is desired


Functional - Quality Management/Quality Management/7-10 Years


Desktop Tools/Microsoft Word/4-6 Years/End User

Desktop Tools/TE Microsoft Excel/4-6 Years/End User

Desktop Tools/Microsoft Outlook/4-6 Years/End User

Desktop Tools/Microsoft SharePoint/4-6 Years/End User


Benefits Management/Maximizing Healthcare Quality/ADVANCED

Finance/Delivering Profit and Performance/ADVANCED

Finance/Profit and Quality Vigilance/ADVANCED


General Business/Demonstrating Business and Industry Acumen/MASTERY

General Business/Consulting for Solutions/MASTERY

General Business/Communicating for Impact/ADVANCED


Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of KanCare members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support youall the way.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

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

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.


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.