Aetna Health Care QM Project Manager in San Diego, California

Req ID: 52593BR

POSITION SUMMARY

The clinician will provide support and guidance for NCQA accreditation activities. The person will work with utilization management and/or use case management. The individual completes file review and interact with NCQA surveyors, completes standards of care as it relates to NCQA, and completes forms as it relates to NCQA standards.Fundamental Components:

Clinician to support NCQA accreditation. Previous experience in case management, utilization review

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.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/American Nurses Credentialing Center is desired

Quality Management/ is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

Functional - Leadership/Act as company spokesperson to external constituents/1-3 Years

Functional - Quality Management/Quality Management/1-3 Years

Functional - Quality Management/FE NCQA accreditation/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

REQUIRED SKILLS

General Business/Communicating for Impact/ADVANCED

Leadership/Anticipating and Innovating/ADVANCED

DESIRED SKILLS

Leadership/Driving a Culture of Compliance/MASTERY

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 here to review the benefits associated with this position.

Aetna takes our candidates'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