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QM Manager NQM Regualtory team

Primary Location: Jacksonville, Florida
Additional Locations: AZ-Phoenix, CA-San Diego, CA-W. Sacramento, CO-Denver, CT-Hartford, FL-Jacksonville, FL-Tampa, IL-Chicago, MA-Wellesley, NY-New York, PA-Blue Bell, TX-Houston
The Manager, Health Care Quality Management is accountable for health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop compliant strategies and solutions aligned with company activities and values. Links the quality and clinical team activities to support regulatory compliance requirements for the Commercial and Medicare work through policy support, market conduct exam support and development of improvement plans as required.

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 and clinical initiatives with a focus on regulatory compliance requirements This role includes managing 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/compliance into their strategic and operational plans. Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers. Supports the development of and implements the infrastructure of the QM program 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 regulators and other customers while meeting departmental objectives. . Translates knowledge of subject and business needs into clear strategic plans in collaboration with department leaders. 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 or clinical management roles in the healthcare industry or health care regulatory environment
Knowledge of health care regulatory compliance such as CMS or credentially.
Demonstrated leadership abilities with Performance Management and Change Management in a matrix environment.
Excellent organizational skills, able to drive team projects and manage deliverables
Professional communication skills both written and verbal; to present data to Executive level team members.
Proficient skill level with MS Excel, MS PowerPoint, Outlook and other programs used for reporting data.

Bachelor's degree or comparable experience, Nursing degree, or other comparable healthcare experience.

Additional Job Information:

This role requires the ability to quickly shift focus and daily activity to support regulatory exams and to develop timely responses to inquiries internally or externally.

You will manage a dynamic team of individuals that work across departments to develop efficient, effective and compliant solutions to health care regulatory requirements while supporting accreditation and business needs.

Required Skills:
Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance, Leadership - Creating Accountability

Desired Skills:
General Business - Communicating for Impact, General Business - Ensuring Project Discipline, Leadership - Collaborating for Results

Functional Skills:
Clinical / Medical - Quality management, Leadership - Lead a business in different geographies or multiple markets, Lega - Compliance - market conduct/regulatory exams, Medical Management - Medical Management - Legislative and regulatory compliance

Technology Experience:
Desktop Tool - Microsoft PowerPoint, Desktop Tool - TE Microsoft Excel

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. 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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