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Aetna is now a CVS Health Company

Mgr, Health Care QM

Primary Location: Plantation, FL
Additional Locations: FL-Plantation
This position is open to candidates located in AL, AR, MS, FL, GA, TN, NC, SC, MD and VA in an Aetna office.

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.

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. 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 Network, Medicare Stars and across all segments in their efforts to acquire and retain customers, supporting quality presentations, education and requests for measurement information. Performs strategic analysis of business performance data to address organizational goals. In partnership with business owners supports design /development of new or enhanced products, program and services. Influences department business owners and leaders to reach solutions to meet the needs of providers, members, regulators and other customers while meeting departmental objectives. Translates knowledge of subject and business needs into clear strategic business plans. Serves as a technical, professional and/or clear business expert that may cross multiple business functions. Directs and oversees provider engagement outreach of their team.

Background Experience:
  • 6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management
  • Demonstrated leadership ability/previous experience
  • Bachelor's degree, Nursing degree or other comparable healthcare experience required
  • Moderate amount of HEDIS / Medicare Stars knowledge

Additional Job Information:
  • 401K
  • Tuition Assistance
  • Medical Benefits
  • Dental Benefits
  • Vision Benefits
  • Wellness Rewards
  • Positive Team Environment

Required Skills:
Leadership - Collaborating for Results, Leadership - Creating Accountability, Leadership - Engaging and Developing People

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Anticipating and Innovating, Leadership - Driving Strategic and Organizational Agility

Functional Skills:
Clinical / Medical - Management: < 25 employees, Clinical / Medical - Quality management, General Management - Process & quality improvement, Leadership - Lead a business in different geographies or multiple markets, Project Management - Project Leader

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

Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
10 - 25%

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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