Aetna Director of Quality Management (Aetna Better Health of Texas) 40267BR in Dallas, Texas

Req ID: 40267BR


Aetna Better Health of Texas is looking for a Director of Quality Management to join our team. We are part of Aetna Medicaid. Our company is a national leader in managing care and services for people with special needs. We bring over 28 years of experience helping those whose health is most at risk. Together, we support about 2 million Medicaid members in 16 states.

The Texas Medicaid programs Aetna Better Health of Texas serves include: Medicaid (STAR)Medicaid (STAR Kids)Children s Health Insurance Program (CHIP)CHIP Perinate

The Director of Quality Management is responsible for coordinating and implementing quality initiatives designed by the health plan to continuously improve all aspects of health care delivery. This includes communication and monitoring of initiatives as well as promoting culture changes that support an environment of quality. This position is also responsible for coordinating and implementing HEDIS, CAHPS and other quality programs while assisting with data analysis and important report preparation. The Director works closely and collaboratively with various functional areas of the health plan inclusive or providers to achieve the goals and objectives of the QI program.

Fundamental Components:

Provides leadership and support in establishing and directing the Quality Program consistent with the delivery systemDevelops and / or maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standardsCollaborates with physicians to execute the implementation of the clinical quality data initiatives as defined by segmentProvides expertise to the training department on HEDIS measures and tools that support collection of and communication about HEDIS to the enterpriseWorks with Medicaid segment on developing and implementing HEDIS member engagement strategiesWorks with leadership to provide information or data as requestedFacilitates, integrates, and / or coordinates the implementation and evaluation of identified quality improvement / HEDIS activities as requested Promotes understanding, communication and coordination of all quality improvement program components

Participates in requested evaluations and auditsCoordinates reporting on quality initiatives to all appropriate committeesAssists with the development of the QM Work Plan, the QAPI, and the Evaluation and the monitoring of Work Plan activities as they relate to process improvement.Participates in various teams, committees and meetings at any level required to maintain business necessityMaintains QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and proceduresMaintains current knowledge of regulatory requirements associated with the QI programOversees HEDIS data submission processLeads NCQA accreditation efforts Performs all other related duties as assigned


8-10 years clinical leadership

Ability to synthesize program performance and clinical outcomes


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


Healthcare Management/Certified Professional in HealthCare Quality is desired

Quality Management/National Committee For Quality Assurance is desired

Quality Management/Six Sigma is desired

Quality Management/National Association Healthcare Quality, NAHQ is desired


Functional - General Management/Data analysis & interpretation/1-3 Years

Functional - Management/Management - Administration/7-10 Years

Functional - Leadership/Act as company spokesperson to external constituents/1-3 Years


Fast-Paced growing MCO needs seasoned Quality Management Professional to join our team!

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 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. #LI-HL1

Job Function: Health Care