Chief Operating Officer, Aetna Better Health of Louisiana

$131,500 - $303,195/Yr

CVS Health - Kenner, LA

Full-time - Executive

Kenner, LA

Health and Personal Care Retailers

About the position

Aetna Better Health is Aetna's Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That's why Aetna Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. Aetna Better Health of Louisiana is seeking an experienced leader with vast operational knowledge of government programs such as Medicaid, Medicare, and Dual Eligible for its state-wide managed Medicaid business in the role of Chief Operating Officer (COO). The Chief Operations Officer has the responsibility for overseeing all high-level operational activities of various functional areas, beyond traditional service operations, which may include Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, and Medical Management for our state-wide managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentlessly pursuing change that is best for the organization and its customers. The COO will be required to oversee the Medicare and Long-Term Care lines of business as well. This position will assist the Plan CEO in the successful growth and performance, including financial management of the Plan as well as interface, collaborate and work cooperatively with corporate office functional leaders and centralized shared services business departments. The COO is a valued leader in the organization and an extension of the CEO both within the Plan and externally with the regulatory agencies and other state departments.

Responsibilities

• Providing day-to-day leadership and management to a service organization that mirrors the mission and core values of the company.
• Driving the Plan to achieve and surpass performance metrics, profitability, and business goals and objectives.
• Leading and managing all operational activities of various functional areas, beyond traditional service operations.
• Ensuring employee compliance with, and measurement and effectiveness of all Business Standards of Practice.
• Providing timely, accurate, and complete reports on the operating condition of the Plan.
• Developing policies and procedures for assigned areas and ensuring that other impacted areas review new and changed policies.
• Assisting the Plan leader in collaborative efforts related to the development, communication, and implementation of effective growth strategies and processes.
• Spearheading the implementation of new programs, services, and preparation of bid and grant proposals.
• Collaborating with the Plan management team to develop and implement action plans for the operational infrastructure.
• Assisting in defining marketing and advertising strategies within state guidelines.
• Participating in the development and implementation of marketing policies for the Plan.
• Aiding in preparation and review of budgets and variance reports for assigned areas.
• Working cooperatively with Network Development team in the development of the provider network.
• Serving as a liaison with regulatory and other state administration agencies.
• Assuring compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas.
• Ability to travel in-state; travel to various locations including the office and to attend state meetings, etc., as required.
• Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce.

Requirements

• 10+ years' work experience that reflects a proven track record of government programs such as Medicaid, Medicare, or Dual Eligible.
• Deep understanding of claims systems and processes, value-based contracts, TPL/COB, Pharmacy claims.
• Must possess an understanding of how compliance and quality programs (NCQA and HEDIS) affect the Plan.
• Proficient on credentialing, provider relations, network development.
• High acumen on the marketing of Medicaid and the communications to members and providers.
• Working knowledge of the interaction between physical and behavioral health.
• Ability to work collaboratively across many teams, prioritize demands from those teams.
• Demonstrated leadership with relevant initiatives: business process optimization, enterprise business project management.
• Ability to work a Hybrid Model (in office Tuesday / Wednesday / Thursday) out of the Kenner, LA office.
• Demonstrated a commitment to diversity, equity, and inclusion.

Nice-to-haves

• Master's degree preferred.

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.
• Free development courses.
• CVS store discount.
• Paid Time Off (PTO) or vacation pay.
• Paid holidays throughout the calendar year.