Aetna Health Care Quality Management Projct Manager ( RN/ LPN) in Morrisville, North Carolina
Req ID: 42617BR
Manage, monitor and accountable to drive influences for health care quality projects and initiatives through design, development, and implementation. Assimilates data and information to proactively develop quality activities aligned with company and business strategies and values. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business areas to meet business needs and accomplish organizational goals. Serves as a clinical resource and subject matter expert (SME) on aspects of the quality programs to support and promote successful accreditations. Proactive participant in team and business relationships, both internally and externally.
Fundamental Components include, but are not limited to:
Evaluate complex data and information sets (e.g. accreditation/regulatory standards or requirements, HEDIS data) Conduct quantitative and qualitative data analysis Convert the results of data analysis into meaningful business information and conclusions Complete QM documents based on interpretation and application of business requirements Document QM activities to demonstrate compliance with business, regulatory, and accreditation requirements Develop, implement and/or monitor QM projects and QM Work Plan Activities (e.g. audits, clinical reviews, etc.) Prepare and report business information to internal and external constituents - Consult with key constituents to develop action or solutions Deliver business information to internal and external constituents via formal presentations and/or written communications. Facilitate or actively participate on work groups to evaluate, perform a barrier analysis, and make recommendations for corrective actions Demonstrate continuous quality improvement in the ongoing maintenance and implementation of quality improvement projects and initiatives Evaluates and prioritizes recommendations for quality improvements to management and/or customers. Provides enhancement recommendations to business processes, policies and department infrastructure to improve operational efficiency Exhibits behaviors outlined for a Health Care QM Project Manager
5 to 7 years clinical and managed care experience in the healthcare industry; Requirement 2-3 operational quality management; Requirement Project management and leadership experience; Requirement LPN, RN clinical license accepted Self starter and project management; Requirement
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Nursing License is desired
Functional - Project Management/Project Manager/1-3 Years
Functional - Project Management/Cross-functional project management/1-3 Years
Functional - Quality Management/FE NCQA accreditation/1-3 Years
Functional - Products-Medical/All Aetna Standard Plans/1-3 Years
Functional - Products-Medical/Individual Medicare Advantage Plan/1-3 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Adobe Acrobat Suite v5/1-3 Years/End User
General Business/Applying Reasoned Judgment/MASTERY
General Business/Turning Data into Information/MASTERY
Leadership/Collaborating for Results/MASTERY
Leadership/Developing and Executing Strategy/ADVANCED
Service/Improving constituent-focused Processes/MASTERY
Based on current work location, will consider telework. Any external new hire required to be in office if space is available. Open for all locations.
ADDITIONAL JOB INFORMATION
This position will offer the candidate the opportunity to join Aetna's National QM team and contribute to the QM program, accreditation and compliance efforts across the organization. The position will offer opportunities to utilize project management skills in working with business partners across the organization in order to accomplish goals. The ability to improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives.
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