Arizona – Remote HEDIS Project Manager

Job Overview

  • Clinical License RN
  • State(s) AZ

Job Description
The HEDIS Project Manager will join a strong, supportive, and diverse project management team. This position allows for the nurse to positively impact a large number of individuals through the work they will perform. The work done in this department has a beneficial effect on our plan members by providing outreaches to improve their overall health and wellness through prevention. The member is always at the heart of what we do and why we do it, and we are always striving to do even better each year than we
already are.

The HEDIS Project Manager is responsible for managing 1-4 CMS STAR and HEDIS measures throughout the year, including
developing outreaches to members and providers to improve compliance with preventative health and wellness measures.
During the HEDIS annual audit, the HEDIS PM will manage 1-2 specific HEDIS hybrid measures as the subject matter expert.
The HEDIS Project Manager will also work on the active, year-round medical record review project to support the HEDIS audit.

Standard business hours are Monday-Friday Arizona time.
No weekends and no holidays!

Fundamental Components
-The priority focus of the HEDIS Project Manager is to improve
member compliance to health and wellness preventative measures.
-This is accomplished primarily through the development of
outreaches to both members and providers, including educational
-The HEDIS PM becomes a subject matter expert on their
measure(s) through research and utilization of provided resources,
enabling the PM to explore new or improved methods for
outreaching to our members and providers.
-Annually, during the HEDIS audit, the PM will manage 1-2 hybrid
measures for which they are a subject matter expert.
-This management also includes training contingent staff on what
data to obtain from member charts for their specific hybrid
measure(s), and over-reading the data collected to ensure
-Throughout the year, the HEDIS PM will also work to manage
incoming medical record data received through the Year-round
medical record review process.

Background Experience
-3+ years of clinical experience is required
-HEDIS annual audit & Medicaid experience is required
-1+ year of quality management or project management experience is required
– Computer Savvy
– Proficient with technology
– Training experience
– Self starter and independent worker
– Work from Home/virtual/remote experience preferred
-Managed care experience is preferred
-Year-round record review experience is preferred

-An active, unrestricted and good standing Registered Nurse License in the State of Arizona is required

Bachelor’s degree or equivalent experience

Percent of Travel Required
0 – 10%

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.


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