Health Care Quality Management Project Manager

AETNA – Baton Rouge, LA

POSITION SUMMARY Project Management of the State Performance Project for Maternal Health and High Risk pregnancy program. Ensuring receipt of maternal and postpartum care and promotion of family planning services, development of the preventive health strategy, and interfacing with community partners and State administrators. Fundamental Components: Composition and reporting of Performance Improvement Project (PIP) baseline, annual updates, and monthly State reporting metrics. Preparation and presentation of metric reports, challenges, interventions and Health Plan specific initiatives to State representatives. Coordination with informatics and care management in generation of State specific reports to close gaps in care for our Maternal Health and high risk pregnancy members. Development and implementation of education and training programs of primary care providers, obstetricians, gynecologist, and the members for which we services, to include mailers, telephone scripts, handouts, newsletter articles, guides. Medical record data abstraction and data file validation to HEDIS and State technical specifications. Meeting with external community partners and vendors to ensure implementation of interventions to close gaps in care. Monthly PIP coordination meetings with care management and HEDIS intervention team to ensure coordination of member care and completion of initiatives. BACKGROUND/EXPERIENCE: 5+ years clinical and/or managed care experience in the healthcare industry required HEDIS performance measures required 1+ years of Quality Management experience required 1+ years Six Sigma experience preferred Project management and data analytics experience required Leadership experience preferred Technical writing skills required RN and/or Masters level with Quality Management Experience Bachelor degree with CPHQ certification and/or lean sixth sigma certification EDUCATION The highest level of education for candidates in this position is a Masters degree or equivalent experience. LICENSES AND CERTIFICATIONS Nursing/Registered Nurse (RN) is required Quality Management/Six Sigma is preferred Quality Management/Certified, Health Care Quality and Management is preferred Quality Management/Certified Manager of Quality/Organizational Excellence is preferred FUNCTIONAL EXPERIENCES Functional - Quality Management/Quality Management/1-3 Years Functional - Project Management/Project Leader/1-3 Years Functional - Quality Management/Six Sigma/1-3 Years Functional - Information Management/Applied research and statistical analysis/1-3 Years Functional - Administration / Operations/Document production & distribution/1-3 Years TECHNOLOGY EXPERIENCES Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User Technical - Desktop Tools/Microsoft Word/4-6 Years/End User Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User Technical - Remote Access/Cisco VPN (hardware and software suite)/1-3 Years/End User REQUIRED SKILLS Leadership/Anticipating and Innovating/ADVANCED General Business/Applying Reasoned Judgment/MASTERY DESIRED SKILLS Leadership/Developing and Executing Strategy/ADVANCED Telework Specifications: Baton Rouge and/or Kenner office location. Telework will be considered for internal and external applicants ADDITIONAL JOB INFORMATION Autonomous role working independently with internal and external partners. 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. 57455

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