Aetna 2 Quality Management Sr. Consultants - PA Medicaid Health Plan (51281BR) in Pittsburgh, Pennsylvania

Req ID: 51281BR

Aetna Better Health of PA is hiring 2 Quality Management Senior Consultants to support our growing Medicaid Health Plan!

These 2 positions are Work From Home Full Time, with the requirement that the employee reside in PA to cover the specific assigned territories (Southeast, Southwest, New West, Lehigh/Capital and New East)

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. 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 desired:

(*) 3 - 5 years experience in healthcare or managed care quality management

(*) Project management experience.

(*) HEDIS and/or coding knowledge

(*) 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

EDUCATION

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

LICENSES AND CERTIFICATIONS

Project Management/Six Sigma Trained is desired

FUNCTIONAL EXPERIENCES

Functional - Quality Management/Quality Management/1-3 Years

FunctionalExperience/FunctionalFocus/1-3 Years

Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/4-6 Years/Power User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

ADDITIONAL JOB INFORMATION

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.

#LI-MR1

Job Function: Quality Management