Aetna Director, Health Care Quality Management in Cincinnati, Ohio

Req ID: 50690BR


The Director Health Care Quality Management implements a HEDIS management strategy that meets internal and external constituent expectations. Uses innovation, integration, and information links the quality management activities to business goals. 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.

Fundamental Components:

Lead and Manage all aspects of HEDIS 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. Assures compliance with all State and Federal HEDIS requirements.

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

Provides direction setting and leadership, with accountability for HEDIS program(s), projects and initiatives. Manage complex projects, people, and business priorities to achieve member and provider 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.


  • 5 to 7 years of management or leadership experience within the managed health care and/or quality management areas.

  • Must have solid knowledge of HEDIS, NCQA Audits and STAR Measures Programs.

  • Previous experience that reflects a proven track record or proficiency in the competencies noted.

  • Proven management experience in a metrics driven and deadline driven environment.

  • Able to coach and mentor team members.

  • Previous Change Management experience.

  • Demonstrated ability to plan, organize, and execute multiple functional business objectives.

  • Good business acumen, professional communication skills both written and verbal

  • Advanced skill level with MS Office Programs: Word, Excel, PowerPoint and Outlook.


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

    LICENSES AND CERTIFICATIONS: (Preferred / not required)

    Quality Management/ is desired

    Leadership/ is desired

    Healthcare Management/ is desired


    • Quality Management/Quality Management/4-6 Years
  • Change Management/ 4-6 Years


  • Possible telework available

  • Locations listed are the preferred locations.

  • Travel is up to 25% and may be more if not near an Aetna office.

    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