Aetna KS Medicaid Health Care Quality Management Consultant in Overland Park, Kansas
Req ID: 52092BR
Implements an all product quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes. Using innovation, integration, and information links the quality management activities to business goals. Health Care Quality Management includes, but is not limited to, QM Programs/Infrastructure, behavioral health QM, credentialing, delegation and regulatory accreditation support, clinical and service measurement and improvement and quality of care investigations. Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives.
Processes and evaluates complex data and information sets (e.g. accreditation/regulatory standards, HEDIS data, Geoaccess data)
Performs quantitative and qualitative data analysis
Converts the results of data analysis into meaningful business information and reaches conclusions about the data
Prepares and completes QM documents based on interpretation and application of business requirements
Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
Assists in the development and implementation of QM projects and activities
Accountable for completing and implementation of QM Work Plan Activities (e.g. QM committees, audits, clinical reviews)
Prepares and reports business information to internal and external constituents and consults with constituents on solutions to business issues (e.g. delegates, committees, workgroups, regulators)
Evaluates and makes recommendations for corrective actions regarding credentialing events and potential quality concerns. May require clinical knowledge
Responsible for the ongoing maintenance and implementation of quality improvement projects and initiatives
3+ years work related experience in the healthcare industry is required. Proficiency with MS Office Suite applications; ability to utilize other software and applications with strong keyboard navigation skills, required.
5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management is required.
Education and Certification Requirements:
Bachelor's degree, Nursing degree, or other comparable healthcare experience.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Desktop Tools/Microsoft Outlook/4-6 Years/End User
Desktop Tools/Microsoft Word/4-6 Years/End User
Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Desktop Tools/Microsoft SharePoint/4-6 Years/End User
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Promoting Health Information Technology/FOUNDATION
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
Leadership/Collaborating for Results/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
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.
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.
Job Function: Quality Management