This is a work at home (WAH) telework position. Candidate must be within commuting distance to an Aetna office location, and located in PST or MST.POSITION SUMMARY
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.
Processing of Credentialing Committee files within required timelines and in accordance with accreditation standards, regulatory guidelines and all applicable policies/procedures. Activities include preparation of Credentialing Committee materials to include scheduling of meetings, confirmation of attendees, preparation of electronic committee binder, data gathering from external sources, pre-committee file consultation, completion of minutes and retention of documentation.
Assist with NCQA Accreditation surveys, regulatory audits, HEDIS and other QM projects as requested. Communicate with internal and external constituents throughout the credentialing process.
A commitment to exceed internal and external constituent expectations. Must be well organized and use time and resources effectively to perform responsibilities accurately and efficiently. Must be willing to work hours in support of the West Coast. Must be able to work with minimal supervision, be proactive and self-directed. Ability to interact with all levels of the organization as well as with external constituents. Exhibits clear and concise oral and written communications. The ability to learn new technology quickly. Computer competency is required (Adobe Standard, Word, Excel, Outlook). Managed Healthcare experience suggested. Experienced in NCQA credentialing standards.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Quality Management/Credentialing/1-3 Years
Quality Management/NCQA accreditation/1-3 Years
Leadership/Act as company spokesperson to external constituents/1-3 Years
Project Management/Cross-functional project management/1-3 Years
Aetna Applications/Enterprise Provider Database System/1-3 Years
Aetna Applications/Credentialing and Recredentialing Data Sys/1-3 Years
Desktop Tools/Adobe Acrobat Suite v5/1-3 Years
Desktop Tools/Microsoft Excel/1-3 Years
Desktop Tools/Microsoft Word/1-3 Years
General Business/Applying Reasoned Judgment
Leadership/Driving a Culture of Compliance
Leadership/Collaborating for Results
General Business/Maximizing Work Practices
Service/Improving constituent-focused Processes
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Aetna - 11 months ago
Aetna is about more than just doing a job. This is our opportunity to re-shape health care for America and across the globe. We are...