Registered Nurse (RN) - Health Care Quality Management (QM) Project Manager

In this position, you can work at home from anywhere in the USA. The standard hours for this position are Monday- Friday 8am- 5pm.

The QM team members are accountable for: supporting NCQA continuity and coordination, CM, DM, MR and UM standards which also include file audits and mock surveys. Opportunity for the candidate to actively participate in the development and ongoing implementation of Quality Management Work Plan activities at the national level. Candidate will join team of highly motivated health care professionals who are dedicated to improving the quality of health care and services provided to our members and other external customers.

POSITION SUMMARY

Manages and influences health care quality projects and initiatives through design, development, and implementation. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish goals.

Fundamental Components:

Actively participates in the development and ongoing implementation of Quality Management (QM) Program and Work Plan activities. Improve quality activities, products and services, by using measurement and analysis to process, evaluate and make recommendations to meet Quality Management objectives.

Primary responsibilities include to:

- Evaluate complex data and information sets (e.g. accreditation/regulatory standards)

- Conduct quantitative and qualitative data analysis

- Convert the results of data analysis into meaningful business information and conclusions

- Complete QM documents based on interpretation and application of business requirements

- Document QM activities to demonstrate compliance with business, compliance, regulatory, and accreditation requirements

- Develop and implement QM projects and QM Work Plan Activities (e.g. QM committees, audits, clinical reviews,

- Prepare and report business information to internal and external constituents and consult with them to develop solutions

- Facilitate work groups to evaluate, perform a barrier analysis, and make recommendations for corrective actions

- Demonstrate continuous quality improvement in the ongoing maintenance and implementation of quality improvement projects and initiatives

- Exhibits behaviors outlined in Health Care QM Project Manager Competencies

BACKGROUND/EXPERIENCE desired:

3+ years clinical experience is required and 6+ years is preferred

Managed care experience in the healthcare industry and quality management is required

Project management experience is highly preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Nursing License is required

FUNCTIONAL EXPERIENCES

Functional - Quality Management/Quality Management/1-3 Years

Functional - Project Management/Enterprise-wide project management/1-3 Years

Functional - Project Management/Intra-department project management/1-3 Years

Functional - Project Management/Cross-functional project management/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/1-3 Years/Power User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/Power User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/Power User

Technical - Desktop Tools/Adobe Acrobat Suite v5/1-3 Years/Power User

REQUIRED SKILLS

General Business/Communicating for Impact/ADVANCED

General Business/Turning Data into Information/MASTERY

Leadership/Collaborating for Results/MASTERY

DESIRED SKILLS

General Business/Applying Reasoned Judgment/MASTERY

General Business/Maximizing Work Practices/MASTERY

Leadership/Anticipating and Innovating/ADVANCED

Telework Specifications:

Full-Time Telework (WAH)

Telework is a requirement for this position (no physical office location)

ADDITIONAL JOB INFORMATION

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.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Employment Type Regular Career Band Description Professional