Mgr, Health Care QM

Aetna Inc. Houston , TX 77020

Posted 2 months ago

Job Description:


The HEDIS Manager reports to the HEDIS Director, and is responsible for supporting Healthcare Effectiveness Data and Information Set (HEDIS) processes for multiple Medicaid health plans, and is accountable for timelines directly related to HEDIS deliverables.


Position addresses all aspects of HEDIS, with strong emphasis on developing appropriate processes to ensure accuracy of data sources and HEDIS reporting. It includes working with Quality departments and cross-functional teams to design processes to support HEDIS reporting.

Management of Staff: Position manages staff to ensure accuracy and timeliness of data requests, and must hire, train, coach and evaluate performance of direct reports. Must provide training and guidance for team of analysts, and experience in managing remote teams is beneficial.

Support Strategic Development: Must participate in development of long-term analytics strategy, including planning for information data system landscape, and development of future-state architectures and strategies to implement HEDIS solutions. Must also create data-related policies, procedures, and processes to support HEDIS.

HEDIS Audit Support: Manage annual HEDIS data collection activities, including design, implementation, coordination, and timely completion of annual Medical Records review projects. Responsible for developing and managing HEDIS project plan and Roadmap, will function as primary contact for external auditor, and will submit data to external/government agencies within required timeframes.

HEDIS Analysis Support: Position involved in oversight of databases used to support HEDIS reporting, and must manage vendor processes related to calculating HEDIS Quality measures. This requires working with informatics/IT staff, and serving as sole HEDIS analytics Subject Matter Expert by maintaining knowledge of annual HEDIS measures and technical specifications updates from NCQA or CMS.


HEDIS experience is required

Demonstrated leadership ability, and ability to influence others toward a strategic vision across cross-functional teams
5+ years of experience in analysis or interpretation of managed healthcare data, and knowledge of managed care data (e.g., claims/encounter, member/eligibility, providers, pharmacy, lab results)
3+ years of experience using managed care and HEDIS data (e.g., claims/encounter, member/eligibility, providers, pharmacy, lab results, HEDIS measure results), and a strong understanding of basic data relationship concepts in data warehousing
5+ years of experience supporting HEDIS, and demonstrated experience conducting HEDIS audits and successful data submissions to NCQA
5+ years of supervisory/management experience

Technical data manipulation skills, including strong experience with SQL
3+ years of experience in a role that required managing complex projects that required effective planning, tracking, and time/resource allocation to meet project objectives and timelines.

Must be self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast paced environment with a high level of ambiguity.

Experience developing performance measures that support business objectives.

HEDIS experience is required

Preferred: Certified Professional in Health Quality (CPHQ)


Bachelor degree (Masters degree preferred) in a Health Science, Public Health, Quantitative Social Sciences, Statistics, Information Systems, Mathematics, Economics, Computer Science, or health-related field or equivalent experience or equivalent experience.


Quality Management/Quality Management/4-6 Years

Project Management/Issue identification and analysis/4-6 Years


  • Quality/4-6 Years


  • Systems/4-6 Years

Information Technology/Quality engineering / assurance/1-3 Years

Telework Specifications:

Full-Time Telework (WAH)


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 candidates'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.


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Mgr, Health Care QM

Aetna Inc.