This document outlines the behaviors and responsibilities of a Health Care Quality Management Consultant role at Aetna. Key responsibilities include identifying clinical quality indicators and implementing interventions to improve outcomes, providing integrated health information to support decision making, understanding business and regulatory practices in the health insurance industry, and making data-driven decisions. The role also focuses on skills like critical thinking, change management, process improvement, and embracing new technologies.

1. Proprietary
Health Care QM Consultant
(755024) Behaviors
Identify clinical indicators of quality and enhances results
 Analyzes clinical quality statistics to identify outliers
 Performs root cause analysis to determine where intervention is indicated to
improve the quality of results
 Crafts and implements interventions that improve outcomes
 Balances clinical and perceived quality with other outcomes variables
 Analyzes the impact of business decisions on clinical quality
 Educates providers on the value of health information technology and drives
the adoption of H.I.T. solutions
Provide integrated health information to drive informed decision
making
 Provide support to optimize the acquisition, storage, retrieval, and use of
health information
 Manage AetnaÆs health informatics website to provide credible health
information to the public
 Promote AetnaÆs health information products and services to consumers,
members, providers and plan sponsors
 Collect diverse health care data and integrate it into useful decision support
for clinicians.
 Analyze patient records against current standards of care to identify gaps in
care and to alert physicians with ôcare considerationsö upon which they can
act
Understand business and industry practices
 Has thorough knowledge of how the health insurance industry works
 Understands the regulatory requirements that drive the health benefits
industry
 Understands the financial metrics that drive AetnaÆs business
 Knows AetnaÆs competition
 Understands unit operation and best practices
Manage multiple priorities
 Multi-tasks to accomplish workload efficiently
 Keeps multiple service responses and constituent research requirements
moving at the same time
 Navigates systems efficiently in all constituent interactions
 Questions processes and suggests improvements

2. Proprietary
 Finds shortcuts and options to address atypical constituent situations
Make data-driven decisions
 Structures the collection of data relevant to complex or cross-functional
issues
 Integrates data from multiple sources into a logic framework that supports
decision-making
 Uses data to make convincing business arguments by presenting the logical
flow of data, interpretations, conclusions and resulting recommendations
 Strengthens business case with data using correlation of variables,
probabilistic/ statistical reasoning, etc.
 Uses data to validate business plans
 Speaks knowledgably about the value of AetnaÆs HIT strategies with
customers and colleagues
Demonstrate critical thinking
 Engages in skilled, active, interpretation and evaluation of observations,
communications, information, and argumentation
 Gives due consideration to the evidence, context and relevant criteria
surrounding the nature of a problem or question
 Recognizes unstated assumptions and values, interprets data and evaluates
arguments to make accurate judgments
 Demonstrates intellectual humility, empathy, integrity, courage, and
confidence to drive fair and purposeful judgment
Drive discipline
 Establishes performance expectations and appropriate measures
 Emphasizes and demonstrates goal commitment and persistence in achieving
goals
 Monitors performance and creates urgency to improve substandard results
 Recognizes, celebrates and rewards high achievement
 Takes appropriate action with marginal or failing performers
 Upholds and applies AetnaÆs policies, practices, code of conduct and
values; complies with applicable laws and regulations
Promote cross functional communication
 Identifies key links required between people and functions to achieve goals
 Creates and communicates across a broad internal and external network
 Uses influence (versus control) to engage people in the achievement of
goals.
 Identifies and engages stakeholders whose support is needed to accomplish
goals
 Successfully works across AetnaÆs functions, segments and markets to get
things done

3. Proprietary
 Initiates and encourages open and frequent communication related to
diversity
Foster a compliant workforce
 Models integrity and ethical behavior in all situations
 Complies with the laws, regulations and ethical standards that govern our
business
 Coaches others on the importance of honoring commitments and acting with
integrity
 Promotes an environment where employees are encouraged to remain ever
vigilant and raise concerns to their managers, Business Compliance Officer
or other compliance personnel
 Takes swift action against those who disregard AetnaÆs ethical and
compliance standards
 Operates within AetnaÆs code of conduct and requires the same of staff
Develop creative solutions
 Demonstrates independent thinking and initiative
 Challenges the status quo
 Actively shares new ideas and concepts that contribute to business success
 Scans environment to generate new ideas and methods for improving
performance
 Analyzes problems or issues from different points of view to find the optimal
solution
Leading change
 Actively participates in leading the change process
 Translates the impact of change for others and guides them through the
process of transformation
 Provides sound business rationale to support the need for change
 Assesses climate in area(s) of responsibility and aligns communications to
drive change acceptance
 Takes personal accountability for achieving required changes
 Eliminates low value tasks not supporting transformation requirements
 Sponsors the adaptation of existing processes and programs to meet
emerging business needs; educates employees on the value of configurable
versus customized solutions
Demonstrate cross-cultural sensitivity
 Demonstrates a sense of empathy, flexibility and creativity informed by
cultural knowledge
 Respectfully engages and leverages faiths, cultures, world views and
experiences different from ones own

4. Proprietary
 Effectively reads situations, contexts and behaviors that are culturally rooted
and reacts appropriately and respectfully
 Effectively leverages cultural, style and generational differences in the
workplace to take full advantage of the value brought by a variety of
perspectives
 Engages, connects and leverages the value of both remote and office-based
colleagues
 Effectively anticipates and resonds to the culturally diverse needs of internal
clients and external customers
Lead the improvement of processes and standards
 Seeks opportunities to try new ways of doing things in order to better serve
constituents
 Uses information about the needs and expectations of constituents to drive
process improvements and to improve work output
 Removes obstacles in serving constituents well
 Participates in process improvement efforts
 Develop and implement quality management programs and initiatives
 Educate business managers on quality improvement methods
Embrace technology
 Advocates the effective use of technologies and provides appropriate
development to build staff competence
 Effectively utilizes advanced functionality of AetnaÆs standard office
technology tools and shares expertise with others
 Applies technology to improve business processes and compliance
 Integrates technology-based processes to link customers, services, and
products