Aetna Health Care QM Projct Mgr in Dallas, Texas

Req ID: 42865BR

POSITION SUMMARY

Participates in the development and ongoing implementation of Quality Management Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives.

Fundamental Components:

Primary responsibilities include to:

  • Please note that this is not a clinical position.

  • Evaluate complex data and information sets (e.g. accreditation/regulatory standards, CAHPS)

  • Conduct and author quantitative and qualitative data analysis

  • Convert the results of data analysis into meaningful business information and conclusions

  • Complete QM documents based on interpretation and application of business requirements

  • Document QM activities to demonstrate compliance with business, regulatory, and NCQA accreditation requirements

  • Develop and implement QM projects and QM Work Plan Activities (e.g. QM committees, audits, clinical reviews)

  • Prepare and report business information to internal and external constituents and consult with them to develop solutions

  • Facilitate work groups to evaluate, perform a barrier analysis, and make recommendations for corrective actions

  • Demonstrate continuous quality improvement in the ongoing maintenance and implementation of quality improvement projects and initiatives

  • Exhibits behaviors outlined in Health Care QM Project Manager Competencies

    BACKGROUND/EXPERIENCE:

    5+ years managed care experience in the healthcare industry and quality management.

    3+ years of Project management and leadership experience.

    Analytical and trending data skills

    Knowledge of HEDIS / NCQA accreditation experience.

    Service/Working Across Boundaries/MASTERY

    Leadership/Collaborating for Results/MASTERY

    General Business/Applying Reasoned Judgment/MASTERY

    EDUCATION

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

    FUNCTIONAL EXPERIENCES

  • Products-Medical//1-3 Years

    • Quality Management//1-3 Years

    Telework Specifications:

  • Position is National and can be based anywhere in the country. Office based versus Telework will be based on candidates location and office space availability.

    For current employees who have the work status of work from home, may stay with that status.

    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 well empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, gender, disability, veteran status, national origin, citizenship, religion, age, sexual orientation, gender identity, marital or family status or genetic information and will not be discriminated against on the basis of those characteristics.We take affirmative action to recruit, select, develop and retain women, people of color, individuals with disabilities and veterans.

    We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    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