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Health Care Quality Management Project Manager

Primary Location: Cary, NC
Additional Locations: NC-Cary
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Description:
This position will be working from home anywhere in the United States.

Manages and influences health care quality projects and initiatives through design, development, and implementation. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish goals. In the Health Care Quality Project Manager position, you will work on auditing and preparing standards of compliance for NCQA accreditation. You will prepare analyses with NCQA guidelines to help ensure all accreditation requirements are met. You will be accountable for health care quality projects and initiatives through direction setting and leadership. You will proactively develop quality activities aligned with company strategies and values. You will link the quality management activities to business goals. This position requires that you proactively build strong teams and business relationships, both internally and externally. You will serve as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.


Fundamental Components:
Prioritizes and makes recommendations for the design, development, and implementation strategy of quality improvement projects, and initiatives. 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.Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans.Develops, implements, and evaluates the organization’s policies and procedures to meet business needs. Translates and delivers business information to internal and external constituents via formal presentations and/or written communications. Develops documentation templates and systems to support QM projects and initiatives. Educates and consults with unit business managers on quality improvement methods (e.g., work flow, data analysis, metrics).

Background Experience:
  • Project management and leadership experience.
  • 3-5 years clinical and/or managed care experience in the healthcare industry and quality management.
  • RN License preferred, LPN License acceptable
  • Knowledge of NCQA audit processes and procedures.
  • Knowledge of Commercial and Medicare plans
  • CCM preferred
  • Analysis Writing experience preferred
  • Good business acumen
  • Proficient with reporting survey results and data gathered
  • MS Office Programs: Excel, Word, Power Point, and Outlook.
  • Demonstrated leadership , project management ability.


Additional Job Information:
On a daily basis, the expectations require this role to actively monitor deadlines related to accreditation and regulatory requirements while exhibiting the following behaviors: Innovation, Caring, Collaboration, Accountability, Integrity

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Creating Accountability

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Creating Accountability

Functional Skills:
Clinical / Medical - Quality management

Technology Experience:
Aetna Application - Aetna Total clinical View

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

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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