Job Description
Job Description
Fully remote.
Schedule Monday-Friday, standard business hours typically.
On call after hours responsibilities are shared.
Oversees the Quality of Care team as well as implementation of ongoing execution of the strategic and operational business plan for the business segment's clinical quality management operations.
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.
* 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 potential quality concerns. Requires
clinical knowledge
* Responsible for the ongoing maintenance and
implementation of quality improvement projects and
initiatives
-Develop implement, and evaluate policies and procedures, which meet business needs
-Supervisory Experience
Required Qualifications
5+ years work related experience in the healthcare industry.
2 years Experience direct with Quality of care investigations
3 years clinical and/or managed care experience in the healthcare industry and quality management.
3+ years with supervisory/leadership experience of teams up to 20
Experience develop reporting
Population experience DCSCHP, DDD, ALTCS, RBHA, etc.
RN active and unrestricted
Preferred Qualifications
Six Sigma belt
CCM
CPHQ Certification
Education
BSN
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Fully remote.
Schedule Monday-Friday, standard business hours typically.
On call after hours responsibilities are shared.
Oversees the Quality of Care team as well as implementation of ongoing execution of the strategic and operational business plan for the business segment's clinical quality management operations.
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.
* 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 potential quality concerns. Requires
clinical knowledge
* Responsible for the ongoing maintenance and
implementation of quality improvement projects and
initiatives
-Develop implement, and evaluate policies and procedures, which meet business needs
-Supervisory Experience
Required Qualifications
5+ years work related experience in the healthcare industry.
2 years Experience direct with Quality of care investigations
3 years clinical and/or managed care experience in the healthcare industry and quality management.
3+ years with supervisory/leadership experience of teams up to 20
Experience develop reporting
Population experience DCSCHP, DDD, ALTCS, RBHA, etc.
RN active and unrestricted
Preferred Qualifications
Six Sigma belt
CCM
CPHQ Certification
Education
BSN
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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