Chief Operations Officer, Aetna Better Health of Kentucky

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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 Kentucky is seeking an experience 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 COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts. The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Network, Compliance, Health Equity, Medical Directors, Utilization Management, Vendor Management). These activities may include colleague productivity, building and maintaining a highly inclusive and diverse culture as well as ensuring team members thrive and organizational outcomes are met. The COO may also be required to oversee the Medicare and Long-Term Care lines of business. Major Responsibilities • Partner with the Plan CEO to drive successful growth, operational excellence, and overall business performance. • Oversee financial management of the health plan, including budget accountability, revenue target achievement, and P&L performance. • Collaborate with corporate functional leaders and centralized shared services teams to drive operational effectiveness and business results. • Provide leadership and oversight across core operational areas, including: Claims systems and processing, Third-Party Liability (TPL) and Coordination of Benefits (COB), Pharmacy claims operations and their impact on total cost of care, Call center operations and performance and Encounter data management and processing. • Lead and support provider operations activities, including: Provider data management, Credentialing, Provider relations, Network development and contracting, and Value-based care contracting and performance initiatives. • Drive strategies that enhance provider experience while managing medical costs and improving operational outcomes. • Ensure compliance with all applicable state contracts, regulations, executive orders, and healthcare industry requirements. • Partner with Government Affairs and Legal teams to address regulatory, legislative, and compliance-related matters. • Serve as a key advocate with internal stakeholders, state regulators, policymakers, and other external partners. • Build and maintain strong relationships with community-based advocacy organizations and industry stakeholders. • Oversee communications and engagement strategies for members and providers. • Support and promote community-based programs that address Social Determinants of Health (SDOH), including housing, employment, Community Health Workers (CHWs), Peer support specialists and nutrition and food access initiatives. • Apply expertise in the integration of physical and behavioral healthcare, with a strong understanding of the unique needs of the Medicaid population. • Represent the organization externally with regulatory agencies, state departments, community partners, and other key stakeholders. • Act as a trusted executive leader and extension of the CEO, providing strategic leadership both internally and externally. The COO will oversee business operations performance and employee productivity, building and maintaining our highly inclusive and diverse culture, ensuring team members thrive, and organizational outcomes are met. Lead people, build/maintain relationships while driving talent and culture development. Required Qualifications The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes: • 10+ years of work experience reflecting a proven track record of government programs such as Medicaid, Medicare, or Dual Eligible plans. • 5+ years of experience in executive leadership roles with proven track record of proficiency in the operational competencies noted. • Demonstrated success with C-suite stakeholders. • Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions. • Ability to conceive innovative ideas or solutions to meet clients’ requirements. • Excellent communication and relationship management skills and being able to express thoughts in an organized and articulate manner. • Ability to build a climate of trust and respect with regulat