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Director, Health Care Quality Management

Primary Location: Burr Ridge, IL
Additional Locations: IL-Burr Ridge
Act as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of the care and service provided to our members. Lead and Manage all aspects of quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members. Consult and/or work cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers. Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member satisfaction.

Fundamental Components:
Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards. Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc. In conjunction with key business leaders, responsible for directing the activities of quality committees. Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives. Manage complex projects, people, and business priorities to achieve member satisfaction. Develops and implements quality improvement activities nationally and/or within an assigned region. Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results. Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results. Consults with internal/external customers on solutions that impact Quality. Controls expenses while meeting operational, functional and service requirements.Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions.

Background Experience:
Previous experience that reflects a proven track record or proficiency in the competencies noted.
Demonstrated verbal/written communication and computer skills.
Demonstrated ability to plan, organize, and execute multiple functional business objectives.
Previous experience managing staff 5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.
Certified Professional in Health Quality (CPHQ) or other certification a plus Masters degree preferred.
Bachelor's degree desired or equivalent work experience.

Additional Job Information:
Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, Leadership - Collaborating for Results

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Creating Accountability, Leadership - Driving a Culture of Compliance

Functional Skills:
General Management - Multi-functional management: > 25 employees, General Management - Process & quality improvement, Medical Management - Medical Management - Quality Management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Healthcare Management - Certified Professional in HealthCare Quality

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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.


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