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mom35 mom35 (New Member)

What does a quality management consultant rn for aetna do?

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Hi All! I am looking to take a break from the floor and curious as to what a Quality Management Consultant nurse for Aetna does.

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Quality Management Nurse Consultant has experience with the whole picture to improve processes. For instance I found one note years ago and love this application. I found that all the nurses meetings were kept in a binder and on a specific persons computer, thought wow what an antiquated system. You could find each individual weekly meeting on the nurse drive but had to search through each one to find out what you were looking for. I put those all on one note under one tab where you could search by date or by subject and all nurses had access to this. This was internal quality management improvement and administrative driven.

All these ideals we each have to make the nursing job easier within the policy/procedure or perhaps change the policy/procedure to make it more user friendly and up to date. You are continually looking at each nurse and trying to improve their skills and knowledge of everything from hands on nursing to perhaps their knowledge of electronic records (anything IT). You are looking at patients trying to ascertain how their experience was and what could have been better, you are looking to see what management needs/wants, what the long term and short term company goals are and improve based on those goals. You will work with all employees in all departments to resolve issues, document those issues...(problem, solution and discussion). Basically you are the mom who is running everywhere for everybody solving their issues, documentation of those issues, solving those issues to make it better in hopes it does not happen again and to continue watching those new implements work-fixing again if needed.

Quality management wears many hats but really it is to help the nursing staff and management improve the day to day operations. It can be hands on and/or administrative driven.

The issue is where change occurs and people do not know about it for what ever reason, you hear things like here we go again, put your seat belt on, or I need to look for another job I am so sick of these changes, management does not understand...

You have to get your diplomatic pants on and allow for the buy in or at least willingness to try a few times. This position can be difficult, challenging, stressful, full of love and hate...and where do I stand today in my bosses eyes and where do I stand with my peers. So I suppose really extra thick skin is needed.

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Since it's for Aetna, which is health insurance, it is around measuring and monitoring quality standards within the company. Some possible responsibilities of quality management could be around making sure that quality measures for health insurance plan accrediting agencies (URAC, NCQA) are being met, tracking performance expectations for customer groups (such as compliance with clinical care, HEDIS scores), providing consultation to the case management and disease management areas for audits. There is also the provider end, which could involve provider credentialing and investigating complaints about providers' quality of care delivery.

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