Aetna Mgr, Health Care QM in Blue Bell, Pennsylvania

Req ID: 52370BR


The Manager, Health Care Quality Management is accountable for 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.

This role 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.

Fundamental Components:

-Makes business decisions based on the results of research and data analysis

-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

-Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives

-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, quality presentations, request for measurement information

-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/or quality management.

  • Solid knowledge of HEDIS/ STARS processes and procedures. Also HEDIS Rates.

    -Demonstrated leadership/ management ability/previous experience with performance management and change management.

  • Able to manage in a deadline driven environment.

  • Strong problem solving experience.

  • Proficient skill level with MS Office Programs: Word, Excel, PowerPoint and Visio.


    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. Bachelor's degree, Nursing degree, or other comparable healthcare experience is preferred.


    • Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

    • General Management/Data analysis & interpretation/1-3 Years

    • General Management/Multi-functional management: < 25 employees/1-3 Years

    • General Management/Project management (non-IT)/1-3 Years

    • General Management/Process & quality improvement/1-3 Years


    • Desktop Tools/Microsoft Outlook/4-6 Years/End User
  • Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

  • Desktop Tools/Microsoft Visio/1-3 Years/End User

    • Desktop Tools/Workstation Utilities (delete, create, move, etc.)/7-10 Years/End User


    Leadership/Engaging and Developing People/ADVANCED

    Leadership/Developing and Executing Strategy/ADVANCED

    General Business/Applying Reasoned Judgment/MASTERY

    General Business/Communicating for Impact/ADVANCED

    Leadership/Collaborating for Results/MASTERY

    Leadership/Anticipating and Innovating/ADVANCED


  • Location is the Northeastern US , near an Aetna office.

  • Less than 10% of travel for special projects and debrief meetings.

    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.