Aetna Healthcare Quality Management Senior Consultant (FL Medicaid) in Sunrise, Florida

Req ID: 53420BR

Position Summary:

Works with internal staff across multiple departments to support the quality management program, including support of quality regulatory and accreditation requirements.

Job Responsibilities:

  • Generate, coordinate and maintain the QM Trilogy documents (program, work plan, evaluation)

  • Coordinate, prepare, and document for the quality management oversight committee

  • Assist with the coordination and documentation for quality subcommittees

  • Lead policy and procedures, including ensuring compliance with contracts and NCQA requirements

  • Track and ensure timeliness for contractual and regulatory submissions

  • Collect and conduct non-HEDIS medical/case record review

  • Manage and document performance improvement projects

  • Contribute to NCQA accreditation analysis and documentation

    Background/ Experience Desired:

  • Bachelor's degree required

  • 3 to 5 years experience in healthcare/ managed care

  • Strong background in Quality Management (QM)/ Quality Improvement (QI)

  • 3+ years experience with Medicaid populations, with preference for experience with Florida Medicaid and/ or Florida Health Kids in managed care

  • Data analysis experience with QIAs and PIPs preferred


    Master's degree preferred.

    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. 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.

    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 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