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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Mgr, Quality Management

Primary Location: Southfield, Michigan
Additional Locations: MI-Southfield
Continuous quality improvement is more than a buzzword it's how we meet customer needs and control costs. Through Quality Management professionals, we put industry-leading practices and principles to work in support of our quality objectives. In this role you will act as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or operational processes that impact customer satisfaction, cost management, and operational efficiency. You will maintain oversight of all quality management functions while consulting and working cross functionally to influence and promote change in order to deliver quality service to our internal and external customers.

Fundamental Components:
Build a strong functional team through formal training, diverse assignments, coaching, mentoring and other developmental techniques
Manage the supervision of 10-15 analysts/auditors/consultants
Direct the development of quality assessment and audit programs, including purpose, scope and approach
Establish and assess standards of quality measures. Measure performance against standards
Evaluate and prioritize recommendations for quality improvement initiatives to senior management and/or customers according to the value, risks, and importance to the organization
Influence change/enhancements to business processes, policies, workflows, and systems in order to improve performance results and organization effectiveness.
Manage a staffing model and strategic plan that addresses immediate and longer-term business demands

Previous experience managing employees is a must
5+ years work experience in the audit environment
Advanced knowledge of claims processing
Demonstrated ability to plan, organize, and execute workflows
Excellent communication skills Ability to clearly articulate a message and get people working on different tasks on the same page so that everyone works toward the same objective
A positive attitude
Strong accountability to take action and responsibility for goals and objectives
Ability to gather/interpret information, make a decision and execute
Demonstrate flexibility and experience with leading employees through change
Demonstrated ability to solve complex problems creatively

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Functional - Management/Management - Quality/1-3 Years
Functional - Management/Management - Claims/1-3 Years
Functional - Quality Management/Quality Management/4-6 Years
Functional - Claims/Quality management/4-6 Years

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/Power User

Telework Specifications:
Part-Time Telework (ex: 2 days office-based, 3 days telework) for external candidates
Considered only for current internal teleworkers (in EST)

This is a great opportunity to be a part of an outstanding team that drives continuous improvement impacting our entire organization!

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates'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.

Potential Telework Position:

Percent of Travel Required:
0 - 10%

Click To Review Our Benefits (PDF)


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