Aetna CA MCD NCQA Mgr in San Diego, California
Req ID: 45068BR
Accountable for NCQA and other health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links the quality management activities to business goals. Proactively builds strong teams and business relationships, both internally and externally. Serves as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.
-Makes business decisions based on the results of research and data analysis. -Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives. -May manage a QM functional department including development and oversight of performance metrics and application of HR policies and procedures. -Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans. -Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers. -Partners with sales and marketing across all segments in their efforts to acquire and retain customers (e.g. responding to RFPs), quality presentations, request for measurement information. -Develops and implements the infrastructure of the QM program and Patient Safety strategy. -Develops, implements, and evaluates the organizations policies and procedures to meet business needs. -Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization. -Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives. -Performs strategic analysis of business performance data to address Plan Sponsor needs. -In partnership with business owners, supports design /development of new or enhanced products and services. -Translates knowledge of subject and business needs into clear strategic business plans. -Serves as a technical, professional and/or business expert that may cross multiple business functions.
-6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management. -Demonstrated leadership ability. -Bachelor's degree, Nursing degree, or other comparable healthcare experience. -Understanding of trends and constituency expectations. Proficiency with MS Office suite.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Quality Management/Quality Management/7-10 Years
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User
Technical - Desktop Tools/Microsoft Word/7-10 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Promoting Health Information Technology/FOUNDATION
Finance/Profit and Quality Vigilance/ADVANCED
General Business/Demonstrating Business and Industry Acumen/MASTERY
Leadership/Fostering a Global Perspective/ADVANCED
Service/Improving constituent-focused Processes/MASTERY
ADDITIONAL JOB INFORMATION
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