Aetna Director Quality Management in Chicago, Illinois

Req ID: 42871BR

POSITION SUMMARY

This key quality leader is responsible for driving quality at a large health Plan, ensuring that the Plans HEDIS, NCQA, EQRO, and other quality goals are attained. The position will also be responsible for working with multiple departments and the state to help drive quality.

Fundamental Components:

Managed care and health plan experience in Medicaid, Medicare or Commercial. The Director will work closely with cross-departmental leaders to drive HEDIS performance measurements and analyses, CAHPS results, prevention and wellness intervention projects to close gaps in care, NCQA accreditation, and PQOCs. Additionally, the individual in this role will work with the Plans Compliance Department on audits, including but not limited to HSAG, CMS, and internal audits, as well as meeting State and CMS quality improvement requirements. We require a strong and experienced leader who has and can successfully plan, facilitate, organize, and manage a large team to innovatively achieve targeted results by deadline. Superb professional verbal and written skills, the ability to multi-task, and change management experience required. Develops and maintains quality department staff through recruiting, selecting, orienting and training employees. Develops and updates the Quality Work Plan, HEDIS Work Plan, and the Prevention and Welness Work Plan. Demonstrated ability to plan, organize, and successfully execute multiple business objectives successfully and by deadline as well as design and implement quality improvement projects (QIPs). Experience with clinical intervention concepts for application to existing or new processes with focus on identification and application to target populations. Communicate clearly and concisely to vertical and horizontal audiences. Experience in Change Management and Project Management a plus.

BACKGROUND/EXPERIENCE desired:

6+ years relevant experience in managed care, healthcare administration, public health administration or clinical field that reflects proficiency in the job description outlined.

Medicaid/Medicare preferred

HEDIS & NCQA experience required

HEDIS auditing experience preferred

Experience managing 10+ direct and indirect reports required

Reporting, analytics and developing actionable tasks

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is desired

Quality Management/Six Sigma is desired

Quality Management/National Association Healthcare Quality, NAHQ is desired

FUNCTIONAL EXPERIENCES

Quality Management/Quality Management/7-10 Years

Quality Management/Six Sigma/1-3 Years

Quality Management/FE NCQA accreditation/4-6 Years

TECHNOLOGY EXPERIENCES

Desktop Tools/TE Microsoft Excel/7-10 Years/

Desktop Tools/Microsoft Outlook/4-6 Years/

Desktop Tools/Microsoft PowerPoint/4-6 Years/

Desktop Tools/Microsoft Word/7-10 Years/

ADDITIONAL JOB INFORMATION

This position has a unique opportunity to build upon the QM Departments foundational processes and procedures, staffing, and skillsets to achieve the Plans HEDIS, NCQA, and CAHPS goals. A successful candidate will be motivated by the opportunity to improve the health and wellness of the Plans underserved population, as well as develop and grow the QM Department.

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