POSITION SUMMARY Manages and influences health care quality projects and initiatives related to Accreditation 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.
Fundamental Components:
Serves as the Quality Improvement Director on the National Medicaid team. Responsible for overseeing all aspects of Accreditation on the national level and supervision of staff as applicable. Has proven experience with NCQA analyses and extensive knowledge of the accreditation standards. Proven experience as a subject matter expert on NCQA standards and requirements. Responsible for developing and executing a national accreditation approach for all Medicaid markets. Leads, guides and assists local health plans with successfully maintaining and achieving accreditation. 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 related to NCQA. Translates and delivers business information to internal and external constituents via formal presentations and/or written communications. Develops documentation templates and systems to support NCQA projects and initiatives. Forms and leads cross-functional workgroups to design and implement initiatives related to NCQA as applicable. Supports business development and footprint growth to acquire and retain customers (e.g., responding to RFPs, quality presentations, requests for information). Educates and consults with unit business managers on quality improvement methods (e.g., work flow, data analysis, metrics). Works with other departments nationally and locally to achieve business excellence. Has proven skills to drive for results and a corporate survey.
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
- Must have 3-5 years experience in managing NCQA accreditation projects
EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Quality Management/Quality Management/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Telework Specifications:
Considered only for locations in a specific region, state, or city; training period in the office may be required
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 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.
Employment Type Regular
Career Band Description Management
