Aetna Performance Improvement Project Manager / Supervisor in Phoenix, Arizona
Req ID: 42650BR
Improve health care quality by partnering with internal and external stakeholders to meet business needs, improving performance measure ratings. Improve rates for physical health performance measures. Analyze, identify and resolve data quality issues. Supervise clerical/population health outreach call team.
Improves outcomes: Provides performance improvement expertise, project management expertise, and technical assistance to SMEs and others to meet deliverables and improve rates on their assigned performance measures.
As the Subject Matter Expert (SME) for certain performance measures, improves rates by designing and implementing PI projects.
Process and evaluate complex data/ information sets (e.g. regulations, HEDIS/performance measure specs, claims, and contracts).
Perform quantitative and qualitative data analysis. Convert the results of data analysis into meaningful business information and reach conclusions about the data.
Conducts performance improvement (PI) projects: prioritize and makes recommendations for the design, development, and implementation strategy of PI projects and initiatives.
Design the data collection methodology, metrics, and data elements needed to measure outcomes and links performance measures and regulatory/contractual requirements to all PI projects.
Develop tools and systems to support PI projects and initiatives. Accurately collect data for PI projects, i.e., audit medical records and analyzes claims data.
Build support for change across business units and stakeholders. Identifies project leaders and scope and identifies impacted parties, business partners, and resources required.
Analyze potential barriers; identifies and implements methods to remove barriers.
Lead efforts to identify evidence-based/best practices, incorporates these into initiatives.
Conduct cost/benefit analyses.
Communicates project status and outcomes; translate and delivers business information to internal and external constituents via presentations and/or written communications. Track and report progress and outcomes.
Prepare high quality regulatory reports in a timely fashion.
Supports business needs: assists in regulatory audits by preparation activities, participating in interviews, and post-audit activities.
Creates documents such as, policies, procedures, work plans and reports in collaboration with team.
May be assigned to assist in other activities, as needed.
Direct reports: 2 (team of population health/clerical). Ensures accuracy, productivity and effectiveness of direct reports.
MSW or MS in Science of Health Care Delivery
Successful managing multi-faceted long- and short-term projects from start to finish
Good business writing skills
Above average computer software skills
Must be comfortable working in a fast-paced, paperless environment
Ability to interpret and communicate complex data/information accurately
Preferred: Leadership experience
The minimum level of education desired for candidates in this position is a Master's degree.
Functional - Project Management/Project Manager/1+ Years
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
General Business/Communicating for Impact/MASTERY
Service/Working Across Boundaries/MASTERY
General Business/Ensuring Project Discipline/MASTERY
Leadership/Developing and Executing Strategy/MASTERY
Service/Improving constituent-focused Processes/ADVANCED
Benefits Management/Promoting Health Information Technology/ADVANCED
Telework is never guaranteed. Telework will be considered after completion of an in-office period of 3 months min, based on demonstrated job performance and business needs. Must live in or near Maricopa County, AZ and be able to commute to the Phoenix office for training and meetings.
ADDITIONAL JOB INFORMATION
This is a unique opportunity to be a part of health care history in Arizona by integrating physical and behavioral health care systems. Mercy Maricopa Integrated Care, administered by Aetna, is bringing a coordinated system of care that will lead to fewer lives lost to preventable and treatable physical illnesses.
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