Aetna Director, Health Care Quality Management in Baton Rouge, Louisiana

Req ID: 55572BR

POSITION SUMMARY

Act as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of the care and service provided to our members. Lead and Manage all aspects of quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members. Consult and/or work cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers. Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member satisfaction.

Fundamental Components:

  • Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.

  • Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.

  • In conjunction with key business leaders, responsible for directing the activities of quality committees.

  • Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives. Manage complex projects, people, and business priorities to achieve member satisfaction.

  • Develops and implements quality improvement activities nationally and/or within an assigned region.

  • Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.

  • Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results. Consults with internal/external customers on solutions that impact Quality.

  • Controls expenses while meeting operational, functional and service requirements.

  • Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions.

Exhibits the following Manager Behaviors: Quickly and effectively learns and adapts leadership style and strategic direction to the changing demands of the internal and external environment, communicates in a candid, transparent and persuasive manner, seeking others input and adjusting approach based on audience and the need. Builds an optimistic environment where teams and individuals trust each other and work together to meet Aetnas goals and create customer and shareholder value. Arrives at appropriate recommendations and solutions in a manner that effectively balances the management of risk with the maximization of opportunities. Demonstrates urgency and holds self and others accountable for achieving high standards of performance and service. Seeks out, introduces and applies innovative ideas to Aetna with input from customers and active involvement in industry, professional, academic and community participation. Identifies the need for and implements improvements in a focused, effective and efficient manner and amongst others

Background/Experience:

Required

  • Louisiana-licensed registered nurse, physician or physician's assistant or is a Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers

  • 5 or more years clinical and/or managed care experience in the healthcare industry and quality management.

Preferred

  • Previous experience that reflects a proven track record or proficiency in the competencies noted, especially HEDIS and NCQA.

  • Previous experience managing staff

EDUCATION

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

LICENSES AND CERTIFICATIONS

Quality Management/Certified, Health Care Quality and Management is preferred

Quality Management/Certified Manager of Quality/Organizational Excellence is preferred

FUNCTIONAL EXPERIENCES

Functional - Management/Management - Quality/4+ Years

Functional - Quality Management/Quality Management/4+ Years

Functional - Quality Management/FE NCQA accreditation/1+ Years

Functional - Quality Management/Six Sigma/1+ Years

Functional - Management/Management - Multifunctional management: < 25 employees/4+ Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1+ Years/End User

Technical - Desktop Tools/Microsoft Word/4+ Years/End User

Technical - Desktop Tools/Microsoft Project/1+ Years/End User

ADDITIONAL JOB INFORMATION

Join a dynamic team and organization that has built a strong quality program that has a solid foundation that needs further growth.

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.

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.