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TX STAR+PLUS Health Care QM Manager

Primary Location: Dallas, TX
Additional Locations: TX-Dallas
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Description:
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. This position is office based; eligible for part time telework consideration after 90 days and demonstrated performance.

Fundamental Components:
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 organization’s 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.

Background Experience:
  • 6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management. Required
  • Bachelor's degree, Nursing degree, or other comparable healthcare degree. Required
  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications.
  • Understanding of trends and constituency expectations
  • Demonstrated leadership ability.


Additional Job Information:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.



Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, General Business - Maximizing Work Practices

Desired Skills:
Benefits Management - Supporting Medical Practice, General Business - Communicating for Impact, Leadership - Collaborating for Results

Functional Skills:
Quality Management - Quality Management

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

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

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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