Aetna HEDIS Director, Health Care Quality Management (49593BR) in Blue Bell, Pennsylvania

Req ID: 49593BR


Implements a quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes especially as it relates to HEDIS. Using innovation, integration, and information links the quality management activities to business goals.

This position can be located anywhere in the U.S.

Fundamental Components: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. Responsible for oversight and management at the shared services level of all aspects of quality programs and projects related to HEDIS. Collaborate with 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 the HEDIS functional area/unit including full accountability for business/financial results related to following as appropriate: HEDIS reporting, accreditation activities and/or member satisfaction.Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.In conjunction with local health plans and 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. Manages complex projects, people, and business priorities to achieve member satisfaction.Develops and implements quality improvement activities nationally and/or in collaboration with local health plans.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.BACKGROUND/EXPERIENCE desired:5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.Strong HEDIS experience with a proven track record or proficiency.Previous experience managing staff.Demonstrated ability to plan, organize, and execute multiple functional business objectives.Demonstrated verbal/written communication and computer skills.Ability to work in a fast paced environment.Certified Professional in Health Quality (CPHQ) or other certification a plus.Masters degree preferred.


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


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Telework Specifications:

Considered for locations in a specific region, state, or city; training period in the office may be required

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