Aetna Quality Management Nurse (RN) Consultant Registered Nurse in Philadelphia, Pennsylvania
Req ID: 54789BR
Registered Nurse in the Quality Department responsible for writing and management of performance improvement projects (PIPs/QIAs), leading work groups aimed at HEDIS improvement, assisting with quality committees and other quality activities as needed and assists with NCQA accreditation efforts for the Medicaid plan. An excellent opportunity to become an integral member of the Quality Management HEDIS team, responsible for leading interdepartmental work groups through to successful achievement of quality goals. Duties include Performance Improvement Plan (PIP) writing, implementation, oversight, and analysis.
Fundamental Components but not limited to the following:
This position is part of the quality management performance improvement team and is primarily responsible for quality activities including PIP/QIA writing, oversight and analysis and oversight of interdepartmental work groups whose goal is to develop interventions aimed at HEDIS and EPSDT improvement. Involvement in annual HEDIS annual record review project.
3+ years of RN clinical experience required
HEDIS experience required
EPSDT experience preferred
Managed Care experience preferred
Project & group management experience preferred
Performance improvement experience (PIP) preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required unrestricted and active
Quality Management/Six Sigma is desired
Functional - Nursing/Quality Management/3 Years
Functional - Quality Management/Quality Management/3 Years
Functional - Nursing/Med Surg/3 Years
Functional - Nursing/Behavioral Health/3 Years
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools
Leadership/Driving a Culture of Compliance/FOUNDATION
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Benefits Management/Maximizing Healthcare Quality/ADVANCED
General Business/Turning Data into Information/ADVANCED
Option for telework will be evaluated after a certain period of employment
Telework considered only for unique circumstances
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 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.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.