Aetna Clinical Quality Program Manager in Atlanta, Georgia
Req ID: 67243BR
Office Based w/ telework potential to evaluated after a certain period of employment: 2000 Riveredge Parkway Atlanta GA
Manages and influences health care quality projects and initiatives through design, development, and implementation. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish goals.
Fundamental Components included but are not limited to:
O Member outreach in an effort to improve member outcomes and compliance with clinical measures (ART, screenings,
medication adherence). Partners with internal and external stakeholders on initiatives that support clinical measure improvement. Prioritizes and makes recommendations for the design, development, and implementation strategy of quality improvement projects, and initiatives. Designs the data collection methodology, metrics, and data elements needed to measure outcomes of QI projects. Translates and delivers business information to internal and external constituents via formal presentations and/or written communications. May forms and lead cross functional workgroups to design and implement QI initiatives. Supports sales and marketing in their efforts to acquire and retain customers (e.g., attending member meetings, developing quality presentations). Educates and consults with unit business managers on quality improvement methods (e.g., work flow, data analysis, metrics).
Qualifications Requirements and Preferences:
Strong telephonic experience and outreach skills to Medicare Advantage patients required
RN license required
Certified Coding Specialist preferred
At least 4+ years of experience in managing projects and programs in a clinical setting preferred
Knowledge and experience in clinical quality programs, such as HEDIS and Medicare Five Stars required
Excellent organization and prioritization skills
Experience in Medicare Advantage required
Medical Management - Certified Coding Specialist, Nursing - Registered Nurse (RN)
Clinical / Medical - Quality management, General Management - Project management (non-IT)
General Business - Communicating for Impact, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs
Additional Job Information:
Candidate should be flexible to juggle multiple priorities as needed to improve member health outcomes, which may include periodic travel to other Southeastern markets and provider groups.
Benefit eligibility may vary by position.
Job Function: Quality Management
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.