Aetna Manager, Health Care QM in Chicago, Illinois

Req ID: 42890BR


The Quality Management (QM) Manager is a key quality leader who is responsible for driving HEDIS results at a large health Plan, ensuring that the Plan meets its P4P and HEDIS standards required for NCQA accreditation. The position will also be responsible for working with inter-disciplinary teams, the State, and CMS to drive quality measures at the Plan.

Fundamental Components:

The QM Manager must have managed care and health plan experience in Medicaid, Medicare or Commercial. The Manager will work closely with cross-departmental leaders and staff to drive HEDIS performance, analyses of HEDIS data, and CAHPS results, as well as preventive and well care intervention projects to close gaps in care. We require a HEDIS-experienced leader who has and can successfully plan and facilitate targeted results by deadline. Experience with NCQA accreditation is a plus. The Manager develops and updates the HEDIS Work Plan and the Prevention and Wellness Work Plan. Demonstrated ability to plan, organize, and successfully execute multiple business objectives successfully and by deadline as well as design and implement quality improvement projects (QIPs). This role works with the Plans Compliance Department on audits, including but not limited to HSAG, CMS, and internal audits, as well as meeting State and CMS quality improvement requirements. Superb professional verbal and written skills, with the ability to communicate clearly and concisely to vertical and horizontal audiences. The ability to manage competing priorities is critical. Experience in change management is required. This role will develop and maintain Quality Department staff through recruiting, selecting, orienting and training new employees, in addition to ongoing development of staff skills. Project management experience is a plus.


6+ years progressive relevant experience in managed care, healthcare administration, public health administration or clinical field HEDIS experience required; NCQA experience preferred. Experience managing direct and indirect staff of 7+ Medicaid and MMAI experience preferred. Experience with clinical intervention concepts, reporting, and data analytics


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


Nursing/ is desired

Audit/HEDIS Auditor is desired

Quality Management/National Association Healthcare Quality, NAHQ is desired

Project Management/Lean Six Sigma is desired


Quality Management/Quality Management/4-6 Years

Leadership/Lead a business in different geographies or multiple markets/4-6 Years

Nursing/4-6 Years

Management/Management - Quality/4-6 Years

Leadership/Lead a major change effortculture change/4-6 Years


Desktop Tools/TE Microsoft Excel/7-10 Years

Desktop Tools/Microsoft Word/4-6 Years

Desktop Tools/Microsoft PowerPoint/4-6 Years

Desktop Tools/Microsoft Visio/1-3 Years


General Business/Communicating for Impact/ADVANCED

Leadership/Collaborating for Results/MASTERY

Finance/Profit and Quality Vigilance/ADVANCED


Leadership/Creating a World Class Workforce/ADVANCED

Leadership/Driving a Culture of Compliance/MASTERY

Leadership/Engaging and Developing People/ADVANCED


This role has a unique opportunity to build upon the QM Departments foundational processes and procedures and skillsets to achieve the Plans HEDIS, NCQA, and CAHPS goals. A successful candidate will be motivated by the opportunity to improve the health and wellness of the Plans underserved population, as well as further develop the QM Department.

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.

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Job Function: Quality Management