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QM Nurse Consultant - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Princeton, NJ Princeton, New Jersey |
About this job
POSITION SUMMARY
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.
Fundamental Components:
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
Exhibits the following Health Care QM Consultant Behaviors
BACKGROUND/EXPERIENCE desired:
Managed Care experience preferred
3-5 years of clinical experience required
5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.
5 to 7 years of HEDIS experience, in data collection and analysis. Ability to interpret results and communicate to internal and external stakeholders (Providers).
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired
FUNCTIONAL EXPERIENCES
Functional - Quality Management/Quality Management/4-6 Years
Functional - Medical Management/Medical Management - Quality Management/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
REQUIRED SKILLS
General Business/Turning Data into Information/ADVANCED
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
DESIRED SKILLS
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
Telework Specifications:
Office located in Princeton, NJ, off major roadway. Downtown Princeton area minutes away
ADDITIONAL JOB INFORMATION
Opportunity to work in a newly established and expanding Medicaid plan.
Ensure high quality of services to plan Medicaid members by working with internal and external groups.
Office located in Princeton, NJ, off major roadway. Downtown Princeton area minutes away.
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.
Employment Type Regular Career Band Description Professional
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.
Fundamental Components:
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
Exhibits the following Health Care QM Consultant Behaviors
BACKGROUND/EXPERIENCE desired:
Managed Care experience preferred
3-5 years of clinical experience required
5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.
5 to 7 years of HEDIS experience, in data collection and analysis. Ability to interpret results and communicate to internal and external stakeholders (Providers).
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired
FUNCTIONAL EXPERIENCES
Functional - Quality Management/Quality Management/4-6 Years
Functional - Medical Management/Medical Management - Quality Management/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
REQUIRED SKILLS
General Business/Turning Data into Information/ADVANCED
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
DESIRED SKILLS
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
Telework Specifications:
Office located in Princeton, NJ, off major roadway. Downtown Princeton area minutes away
ADDITIONAL JOB INFORMATION
Opportunity to work in a newly established and expanding Medicaid plan.
Ensure high quality of services to plan Medicaid members by working with internal and external groups.
Office located in Princeton, NJ, off major roadway. Downtown Princeton area minutes away.
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.
Employment Type Regular Career Band Description Professional