Aetna Senior Director - Medicare Clinical Quality in St Louis, Missouri

Req ID: 37002BR


The Senior Director, Medicare Clinical Quality is responsible for optimizing the integration of Medicare Advantage Star Ratings initiatives across all member-facing care management activities, including case management, disease management and the operations of the Medicare Healthy Outcomes Team. The role is responsible for collaboratively partnering with Aetnas clinical services teams to implement relevant, impactful and efficient care management solutions which result in increased quality and healthy days for Aetna Medicare members.

The role has operational leadership for the Healthy Outcomes Team, a RN clinical team that supports data-driven, targeted member engagement. This position reports in directly to the VP, Medicare Chief Medical Officer, with a strong dotted-line relationship to the Executive Director, Medicare Star Ratings.

Individuals applying should have a demonstrated, results-driven background, and a strong capability for identifying disruptive business improvement opportunities and capturing them via a proactive, collaborative leadership style. This highly visible role collaborates with corporate, regional and local health plan leaders and senior executives on a daily basis, is responsible for directing a high performing team of business leaders, and is accountable for driving the Medicare medical member engagement clinical quality strategy across the Aetna enterprise.

Aetna Medicare is dedicated to providing the best in quality and value to Medicare beneficiaries. Optimizing member clinical outcomes and Star Ratings is a foundational element of our mission.

Fundamental Components: Sets the strategic direction for the team and translates the business plan into vision for staff and stake holders.Develops strategic, operational and tactical business plans to achieve quality clinical outcomes.Manages the Medicare Healthy Outcomes team to increasing levels of impact and efficiency.Works collaboratively with leaders from the Medicare STARS team and National Care Management.Leads a high performing team with clear goals and expectations, ensuring continuous development through training, stretch assignments, coaching, and performance management.Influences stake holders to support key projects/programs to ensure positive outcomes.Drives change in order to improve results.

Background / Experience:

7-10 years of clinical / managed care/ health care industry experience

3+ years of proven leadership experience setting strategic direction & influencing change resulting in quantifiable positive outcomes.

Required: Previous quality improvement/management experience in a managed care organization, Thorough knowledge of Medicare STARS programs; Strong collaboration and creative problem solving skills


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

Telework Specifications:

Part-Time Telework will be considered but position requires on-site office work and travel as well.

Additional Job Information:

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.

Job Function: Quality Management