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Aetna Quality Management Supervisor in Phoenix, Arizona

Req ID: 63840BR

Job Description

This role is work at home with local travel needed for meetings and audits.

Directs and manages workflows for continuous quality improvement through measurement, analysis, training, and consulting

Fundamental Components included but are not limited to:

-Accountable for team objectives and scorecard measures, including the allocation of resources to meet volume and performance standards including Key Performance Metrics (KPM's) and Service Level Agreements, etc.

-Assesses individual and team performance on a regular basis and provides candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards

-Develops, trains, motivates, evaluates and coaches staff on work processes and procedures ensuring individual performance standards are met.

-Is available to staff to answer questions and give ongoing feedback

-Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals.

-Builds a cohesive team that works well together

-Effectively applies and enforces Aetna HR polices and practices, i.e., FML/EML, Attendance, Code of Conduct, Disciplinary Guidelines -Utilizes available incentive programs to reward, recognize and celebrate team and individual successes Ensures compliance with policies, workflows, and procedures

-Cultivates and manages relationships with various external entities, e.g. vendors, customers, and consultants

-Develops and maintains strong collaborative relationships with all business partners to maintain excellent lines of communication and share resources and best practices to meet common goals

-Acts as liaison between staff and cross functional teams, including management, business partners, plan sponsors, etc., communicating quality results, trends, ideas, and solutions

-Manages and/or participates in selected projects and organizational initiatives

-Works with cross functional groups to manage complex issues related to claim or call quality

-May facilitate quality management team sessions to develop and implement quality processes, programs and initiatives

-Proactively analyzes data, identifies trends and issues.

-Recognizes and acts on the needs to improve the development and delivery of products and services.

-Clearly identifies what must be accomplished for successful completion of business objectives

-Coordinates team workloads and priorities

-May participate and represent department in internal and external audits and investigations

-May provide Leadership/Coaching/Mentoring; may be a mentor to others.

-Share business knowledge and coordinate the training and guidance of less experienced staff members

-May facilitate quality management team sessions to develop processes and/or resolve issues

Qualifications Requirements and Preferences:

-Must have an active, unencumbered AZ Registered Nurse license.

-2+ years Behavioral Health experience is required

-5+ years of clinical experience required

-Prior supervisor experience is preferred

-Prior quality management experience preferred

-Demonstrated ability to plan, organize, and execute day to day workflow.

-Demonstrated ability in working cooperatively with co-workers and across departments.


Nursing - Registered Nurse

Functional Skills:

Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Mental Health, Nursing - Quality Management

Technology Experience:

Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Desired Skills:

General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices, Leadership - Creating Accountability

Additional Job Information:

This position will have direct reports who are QM nurses as well as two non-clinical QM staff. This individual will work closely with the Director of Quality Management for continuity of processes and compliance.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Quality Management

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.