Accountable for health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links the quality management activities to business goals. Proactively builds strong teams and business relationships, both internally and externally. Serves as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.
Makes business decisions based on the results of research and data analysis.
Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives.
May manage a QM functional department including development and oversight of performance metrics and application of HR policies and procedures.
Forms and leads cross-functional teams to assist business units in integrating quality into their strategic and operational plans.
Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers.
Partners with sales and marketing across all segments in their efforts to acquire and retain customers (e.g., responding to RFPs), quality presentations, request for measurement information.
Develops and implements the infrastructure of the QM program and Patient Safety strategy.
Develops, implements, and evaluates the organizations policies and procedures to meet business needs.
Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization.
Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives.
Performs strategic analysis of business performance data to address Plan Sponsor needs.
In partnership with business owners, supports design /development of new or enhanced products and services.
Translates knowledge of subject and business needs into clear strategic business plans.
Serves as a technical, professional and/or business expert that may cross multiple business functions.
6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management
Demonstrated leadership ability
Exposure to NCQA is preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Quality Management/Quality Management/4-6 Years
General Business/Communicating for Impact/ADVANCED
Leadership/Driving a Culture of Compliance/MASTERY
Leadership/Developing and Executing Strategy/ADVANCED
General Business/Turning Data into Information/ADVANCED
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 and our customers. We are inspired to make a difference, and we are committed to integrity and excellence. Together we’ll ...empower people to live healthier lives.
Aetna is an equal opportunity and affirmative action employer- People of Color, Women, Veterans, and Individuals with Disabilities.