CVS Health

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HEDIS Project Manager

at CVS Health

Posted: 10/16/2020
Job Reference #: 73891BR
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Job Description

Job Description
Works with internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory and accreditation requirements or meet the objectives of the QM program in support of ongoing improvement of HEDIS performance. Conducts outreach with complex provider partners to share information to improve health outcomes.

Fundamental Components
Takes a role in the development and implementation of QM projects and activities as it related to HEDIS . May require assistance in budget development and staff supervision) Delivers Quality information to internal and external constituents via written and verbal communication May support training of new QM staff regarding program description, work plan and evaluation activities Actively seeks opportunities for process improvement resulting in efficient and effective work streams Independently map out provider outreach work plan and execute deliverables Supports more complex relationships with both internal and external constituents. Consults with constituents on solutions to business issues including education and process improvement opportunities. Support complex provider partners with HEDIS gaps in care, data feed, and remote medical record collection discussions and education. Work closely with the provider partner to enhance collaboration between provider and Aetna. Independently conduct measure research during HEDIS medical record project. Performs oversight of new abstractors

Background Experience
  • Must Have HEDIS Experience
  • Must have History with managing HEDIS Year Round. Including Data drill downs, claim drill down, Populating Reports, etc
  • 5 to 7 years clinical and/or managed care experience in the healthcare industry or quality management.
  • 3 - 5 years’ experience in healthcare or managed care quality management
  • Bachelor's degree, Nursing degree, or other comparable healthcare experience.


Education
Bachelor's degree or equivalent experience

Percent of Travel Required
10 - 25%

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!