Skip to main content

Exec. Director, Medicaid HealthCare Quality

Primary Location: New Albany, OH
Additional Locations: OH-New Albany
Provide executive leadership and develop Medicaid-wide, results oriented quality strategy to drive improvements at the national, regional and market level. Responsible for the overall coordination, implementation, and monitoring of activities to yield quality driven, innovative, compliant, efficient, and cost-effective results.

Acts as an Advocate for, and supports, the Medicaid business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical cost management, and operational efficiency. Consult and/or work cross functionally to influence and promote change to continually deliver quality service to our internal and external customers.

Fundamental Components:
  • Sets the direction of the strategic business plan for the Medicaid quality strategy and translates into vision for staff/others.
  • Ensures the implementation and ongoing execution of the Medicaid Health Care Quality Management Program to support business, regulatory and accreditation requirements, and improve HEDIS results.
  • Fosters a culture of quality using innovation, integration and information to support Medicaid revenue and membership growth while achieving business goals.
  • Establishs strategic relationships with Medicaid executive leadership throughout the organization to develop and remove barriers, if needed, to implement program strategies that meet business, regulatory and accreditation requirements.
  • As a Medicaid business leader, influences all stake holders, internal and external, to support key projects/programs to ensure positive outcomes that deliver on results.
  • Builds strong high performing leadership teams through training, stretch assignments, coaching, performance management and other development techniques.
  • Maintains a working knowledge of legislative changes that may potentially affect Medicaid quality and care management practices and standards.
  • Completes regular data analysis to identify trends that that identify gaps in care for the Medicaid populations.
Collaborate with the Medicaid Clinical and Program Innovations team to address population level interventions that address overall gaps in care supporting the Population Management Medicaid franchise models. ..

Background Experience:
  • 8-10 years clinical/managed care/health care industry experience
  • Previous quality improvement and management experience in a managed care organization required
  • Thorough knowledge of NCQA and/or HEDIS management
  • Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes
  • Proven history managing complex projects and or programs that resulted in cost savings
  • Experience managing large budgets
  • Demonstrated negotiation skills
  • Effective and advanced organizational, decision-making, and analytical skills required
  • Excellent verbal and written communication skills.
  • Proficient computer skills and knowledge of Microsoft Word, Excel and Access
  • Ability to work in a demanding environment
  • Demonstrated ability to anticipate customer needs and requirements
Ability to communicate effectively with all levels of management
  • MD or DO preferred
  • Master’s degree preferred
Certified Professional in Health Quality (CPHQ) or other certification a plus

Potential Telework Position:

Percent of Travel Required:
25 - 50%

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.


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.