AVP, Quality Strategy and Initiatives
About the position
At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and transforming the health care landscape in new and exciting ways every day. We are seeking an AVP, Quality Strategy & Initiatives who will be accountable for the achievement of quality performance and leadership of Aetna's quality government programs, including Medicare, Medicaid, Individual and Family Plans (IFP), and Duals. This leader will focus on HEDIS Hybrid, STARS, Performance Improvement Plans, provider and member enablement, as well as regulatory and accreditation compliance. The individual will lead a cross-functional team consisting of approximately 500 clinical and non-clinical staff. Collaboration with shared service partners is essential to achieve our goals, which includes working with network, contracting, member service, and business leaders across the enterprise, serving a membership of 4.2 million in Medicare and Duals, and 2.4 million in Medicaid. In this role, you will develop and drive competitive market-leading approaches with accurate interpretation of product line related specifications, methodologies, and processes to improve results. You will foster and lead through a complex, matrixed enterprise structure to collaboratively promote Aetna Government Quality Improvement Program and Accreditation. Additionally, you will ensure strong business performance, achieving all Quality Incentive Award (QIA), STAR performance objectives, including Pay for Performance (P4P) targets, growth, retention, and STAR ratings. You will define and regulate a preparedness and compliance culture with federal and state laws and regulations related to quality improvement programs, proactively identifying risks and remediation strategies. Your focus will also include NCQA accreditation across all lines of business, long-term support services distinctions, medication adherence modules, and health equity initiatives. Moreover, you will support CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
Responsibilities
Develop and drive business competitive market leading approaches with accurate interpretation of product line related specifications, methodologies, and processes to improve results.
,
Foster and lead through a complex, matrixed enterprise structure to collaboratively promote Aetna Government Quality Improvement Program and Accreditation.
,
Lead a strong business performance, ensuring all Quality Incentive Award (QIA), STAR performance objectives including P4P targets, growth, retention, and STAR ratings are achieved.
,
Define and regulate a preparedness and compliance culture and discipline with federal and state laws and regulations related to quality improvement program; proactively identify risk and remediation strategies.
,
Focus on NCQA for all lines of business on health plan accreditation, long-term support services distinctions, medication adherence module and health equity.
,
Support CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce.
Requirements
15+ years of experience in healthcare/managed care leadership roles with experience in HEDIS/Medicaid/Medicare/Duals/IFP Quality program performance management, analytics, reporting and forecasting with a regional and national scale.
,
Proven experience driving performance management and meeting/exceeding state, federal contract requirements and operational performance.
,
Experience with achieving STAR rating targets greater than industry average.
,
Strong understanding of state/federal quality requirements and key strategic and operational imperatives/interoperability (data ingestion).
,
Strong problem solving and analytical skills.
,
Ability to build, cultivate, and support teams with excellent leadership skills and the ability to influence line management decisions with data driven facts.
,
Ability to work collaboratively within a matrix organization as well as influence with and without formal authority to drive performance outcomes.
,
Maintain intelligence on competitor capabilities, technology, and overall competitive advantage.
,
Exemplary collaboration across large, matrixed organization stakeholders.
,
Logic and data-driven approach coupled with an elevated level of emotional intelligence, intellectual curiosity, and root cause analysis to drive insights and solutions.
,
Proven experience inspiring and developing a highly focused, cohesive team of professionals accountable for improving health outcomes and enabling market leading performance.
,
Strong change leadership, facilitation, oral and written communication, and presentation skills.
,
Ability to work a Hybrid Model (in office Tuesday/Wednesday/Thursday) out of a local Aetna Hub location.
,
Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Nice-to-haves
Clinician preferred (MSW or RN licensure)
Benefits
Full range of medical, dental, and vision benefits.
,
401(k) retirement savings plan.
,
Employee Stock Purchase Plan.
,
Fully-paid term life insurance plan.
,
Short-term and long-term disability benefits.
,
Numerous well-being programs.
,
Education assistance and free development courses.
,
CVS store discount and discount programs with participating partners.
,
Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
Apply Now
At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and transforming the health care landscape in new and exciting ways every day. We are seeking an AVP, Quality Strategy & Initiatives who will be accountable for the achievement of quality performance and leadership of Aetna's quality government programs, including Medicare, Medicaid, Individual and Family Plans (IFP), and Duals. This leader will focus on HEDIS Hybrid, STARS, Performance Improvement Plans, provider and member enablement, as well as regulatory and accreditation compliance. The individual will lead a cross-functional team consisting of approximately 500 clinical and non-clinical staff. Collaboration with shared service partners is essential to achieve our goals, which includes working with network, contracting, member service, and business leaders across the enterprise, serving a membership of 4.2 million in Medicare and Duals, and 2.4 million in Medicaid. In this role, you will develop and drive competitive market-leading approaches with accurate interpretation of product line related specifications, methodologies, and processes to improve results. You will foster and lead through a complex, matrixed enterprise structure to collaboratively promote Aetna Government Quality Improvement Program and Accreditation. Additionally, you will ensure strong business performance, achieving all Quality Incentive Award (QIA), STAR performance objectives, including Pay for Performance (P4P) targets, growth, retention, and STAR ratings. You will define and regulate a preparedness and compliance culture with federal and state laws and regulations related to quality improvement programs, proactively identifying risks and remediation strategies. Your focus will also include NCQA accreditation across all lines of business, long-term support services distinctions, medication adherence modules, and health equity initiatives. Moreover, you will support CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
Responsibilities
Develop and drive business competitive market leading approaches with accurate interpretation of product line related specifications, methodologies, and processes to improve results.
,
Foster and lead through a complex, matrixed enterprise structure to collaboratively promote Aetna Government Quality Improvement Program and Accreditation.
,
Lead a strong business performance, ensuring all Quality Incentive Award (QIA), STAR performance objectives including P4P targets, growth, retention, and STAR ratings are achieved.
,
Define and regulate a preparedness and compliance culture and discipline with federal and state laws and regulations related to quality improvement program; proactively identify risk and remediation strategies.
,
Focus on NCQA for all lines of business on health plan accreditation, long-term support services distinctions, medication adherence module and health equity.
,
Support CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce.
Requirements
15+ years of experience in healthcare/managed care leadership roles with experience in HEDIS/Medicaid/Medicare/Duals/IFP Quality program performance management, analytics, reporting and forecasting with a regional and national scale.
,
Proven experience driving performance management and meeting/exceeding state, federal contract requirements and operational performance.
,
Experience with achieving STAR rating targets greater than industry average.
,
Strong understanding of state/federal quality requirements and key strategic and operational imperatives/interoperability (data ingestion).
,
Strong problem solving and analytical skills.
,
Ability to build, cultivate, and support teams with excellent leadership skills and the ability to influence line management decisions with data driven facts.
,
Ability to work collaboratively within a matrix organization as well as influence with and without formal authority to drive performance outcomes.
,
Maintain intelligence on competitor capabilities, technology, and overall competitive advantage.
,
Exemplary collaboration across large, matrixed organization stakeholders.
,
Logic and data-driven approach coupled with an elevated level of emotional intelligence, intellectual curiosity, and root cause analysis to drive insights and solutions.
,
Proven experience inspiring and developing a highly focused, cohesive team of professionals accountable for improving health outcomes and enabling market leading performance.
,
Strong change leadership, facilitation, oral and written communication, and presentation skills.
,
Ability to work a Hybrid Model (in office Tuesday/Wednesday/Thursday) out of a local Aetna Hub location.
,
Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Nice-to-haves
Clinician preferred (MSW or RN licensure)
Benefits
Full range of medical, dental, and vision benefits.
,
401(k) retirement savings plan.
,
Employee Stock Purchase Plan.
,
Fully-paid term life insurance plan.
,
Short-term and long-term disability benefits.
,
Numerous well-being programs.
,
Education assistance and free development courses.
,
CVS store discount and discount programs with participating partners.
,
Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
Apply Now