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Healthcare Quality Management Senior Consultant for MN

Primary Location: Minneapolis, MN
Additional Locations: MN-Minneapolis, MN-Plymouth, MN-Saint Louis Park
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Description:
Actively participates in the implementation of the Quality Management Work Plan activities by effectively collaborating with our provider community with the goal of positively impacting our member’s lives through specific provider outreach and engagement objectives.
Works with internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory and accreditation requirements or meet the objectives of the QM program. Conducts outreach with complex provider partners to share information to improve health outcomes.


Fundamental Components:
  • Takes a role in the development and implementation of Quality Management (QM) projects and activities. May require assistance in budget development and staff supervision. Delivers Quality information to internal and external constituents via written and verbal communication.
  • May support training of new QM staff regarding program description, work plan and evaluation activities.
  • Actively seeks opportunities for process improvement resulting in efficient and effective work streams Independently map out provider outreach work plan and execute deliverables.
  • Supports more complex relationships with both internal and external constituents.
  • Consults with constituents on solutions to business issues including education and process improvement opportunities.
  • Supports complex provider partners with HEDIS gaps in care, data feed, and remote medical record collection discussions and education.
  • Works closely with the provider partner to enhance collaboration between provider and Aetna. Independently conduct measure research during HEDIS medical record project.
  • Performs oversight of new abstractors.


Background Experience:
  • 3+ health care provider relations or network experience
  • 3+ health care quality management experience
  • Strong client support, excellent customer service skills
  • Track record of effectively leading projects from inception to completion
  • Experience with developing strategies to improve HEDIS performance
  • Strong data analytics and statistical interpretation
  • Proficient with Microsoft Office suite (PowerPoint, Excel, Word)
  • Strong verbal and written communication, critical thinking, problem resolution and interpersonal skills


Additional Job Information:
The location is the Twin Cities, MN and 100% telework.


Required Skills:
Sales - Knowing Customers, Sales - Knowing Markets, Service - Providing Solutions to Constituent Needs

Desired Skills:
Sales - Delivering on the Promise, Service - Creating a Differentiated Service Experience, Service - Improving Constituent-Focused Processes

Functional Skills:
Clinical / Medical - Network management, Clinical / Medical - Quality management, Communication - Provider communications, Medical Management - Medical Management - Case Management, Network Management - Provider relations

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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