Aetna VA MCD HC QM Project Mgr in Bristol, Virginia

Req ID: 51174BR

Position Summary:

The HC QM Project Manager 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.

Job Responsibilities:

-Serves as the (Regional/National) Project Leader to oversee all aspects of project implementation including budget development and supervision of staff participants (e.g., HEDIS/Accreditation) May seek funding from external sources.

-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.

-Develops documentation templates and systems to support QM projects and initiatives.

-Forms and leads cross functional workgroups to design and implement QI initiatives.

-Supports sales and marketing in their efforts to acquire and retain customers (e.g., responding to RFPs, quality presentations, request for measurement information).

-Educates and consults with unit business managers on quality improvement methods (e.g., work flow, data analysis, metrics).

Background/Experience Desired:

5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.

Project management and leadership experience required.

Managed Care experience preferred.

Bachelor's degree, Nursing degree, or other comparable healthcare experience.

Position requires proficiency with MS Office Suite and navigating multiple systems and keyboarding.

Effective communication skills, both verbal and written.

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.


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

Licenses and Certifications:

Nursing/Registered Nurse is desired

Required Skills:

Benefits Management/Maximizing Healthcare Quality/ADVANCED

Benefits Management/Promoting Health Information Technology/ADVANCED

Finance/Profit and Quality Vigilance/ADVANCED

Desired Skills:

General Business/Communicating for Impact/ADVANCED

General Business/Maximizing Work Practices/MASTERY

Leadership/Fostering a Global Perspective/ADVANCED

Additional Job Information:

Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you'll join a team dedicated to improving the lives of Virginia Medicaid members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Virginia, and we will support you all the way.

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.

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