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Aetna is now a CVS Health Company

Clinical Quality Program Consultant

Primary Location: Atlanta, GA
Additional Locations: GA-Atlanta
This position is located out of the Atlanta, GA office! Will be traveling to visit providers within the Atlanta area.

Supports physicians and members in achieving quality outcomes by facilitating patient compliance with preventive, safety, and chronic care requirements. The program enhances member access to care/services, involves outreach to patients to drive greater adherence to their care needs, and interacting consistently with providers and their staff by sharing/discussing/monitoring available health plan and physician practice data. Consultants can provide subject matter expertise and tools to address and resolve issues that results in better outcomes for Medicare population

Fundamental Components:
The consultant impacts the clinical outcomes of Medicare members though interventions designed to improve compliance with HEDIS, CAHPS, and HOS standards. Interventions include:
  • Present and discuss the quality scorecard report with assigned physicians on a monthly basis or as data becomes available
  • Conduct ongoing medical record reviews to monitor/track compliance with all quality measures and share findings with providers
  • Facilitate interventions to close gaps in care, including direct outreach to patients to educate them on importance of completing screenings and scheduling office visits
  • Collaborate with physician and staff for process improvement activities related to quality
  • Serve as a resource for correct and complete medical record documentation to meet standard requirements
  • Educate providers and office staff regarding HEDIS, CAHPS, and HOS measure requirements
  • Distribute educational material to the provider practice
  • Timely communicate any changes in standard requirements or health plan policies related to quality
  • Work with the provider office to correct/update member demographic information to support successful health plan member outreach, including completion of HRA and care plans on Special Needs Population members
  • Collect and enter supplemental data not reported through claims data

Background Experience:
-3+ years’ work related experience in the healthcare industry (Required)
-3-5+ years clinical and/or managed care experience in the healthcare industry or quality management (Required)
-Unrestricted RN licensure (Required)

Nursing - Advanced Practice Nurse, Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)


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