Aetna Manager, Quality Management in Plymouth, Minnesota
Req ID: 49696BR
Acts as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in adjustments and/or recoveries that impact customer satisfaction, medical cost management, and operational efficiency. Consult and/or work cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers.
Maintains oversight of the quality management function for all Meritain adjustments and projects, including vendor recoveries and inventory, and reinsurance. Drives process improvement and efficiencies throughout the organization, leveraging the adjustment team and individual skill sets. Effectively manages inventory and delivers on key operational business initiatives in support of the adjustment strategy to reduce unnecessary adjustments. Acts as a subject matter expert on adjustments and may participate in global special adjustment projects. Influences change/enhancements to business processes, policies, workflows, and systems in order to improve performance results and organization effectiveness. Consults with internal/external customers on solutions that impact Quality
(-) Collaborate with other business areas to address quality issues
(-) Lead or participate in group presentations on strategic quality management
(-) Assist business partners in integrating quality into their strategic and operational plans
(-) Establish and assess standards of quality measures. Measure performance against standards
(-) Develops and manages a business plan that addresses immediate and longer-term business demands
(-) Formulates and implements strategy for the unit to meet objectives and other business initiatives
(-) Select and build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques
(-) Manage the supervision of teams of analysts/auditors/consultants
3 - 5+ years work experience in an audit or quality environment that reflects a proven track record or proficiency in the competencies noted.
Demonstrated ability to plan, organize, and execute workflows and effectively manage inventory
1-3 years previous experience managing staff a requirement
Knowledge of medical terminology and procedures
1-3 years of claim processing or adjustment experience required
Demonstrated process improvement experience
ABX Yellow Belt certified preferred
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Audit/Certified Internal Auditor (CIA) is desired
Quality Assurance/Quality Improvement Associate Certification (CQIA) is desired
Quality Management/Six Sigma is desired
Quality Management/Certified Quality Auditor is desired
Functional - Leadership/Lead a complex or multifunctional organization/1-3 Years
Functional - Administration / Operations/Management: > 25 employees/1-3 Years
Functional - Quality Assurance//1-3 Years
Functional - Claims/Quality management/1-3 Years
Telework considered only for unique circumstances. In Office locations for Amherst, Tampa, Tuscon, & Plymouth.
ADDITIONAL JOB INFORMATION
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