Chief Operating Officer, Aetna Better Health of Louisiana Position Available In Jefferson, Louisiana

Job Description:

At CVS Health, we’re building a world of health around everyconsumer and surrounding ourselves with dedicated colleagues whoare passionate about transforming health care. As the nation’s leading health solutions company, we reach millionsof Americans through our local presence, digital channels and morethan 300,000 purpose-driven colleagues – caring for people where,when and how they choose in a way that is uniquely more connected,more convenient and more compassionate. And we do it all withheart, each and every day. Position Summary Aetna Better Health is Aetna’s Medicaid managed care plan. Backedby over 30 years of experience managing the care of those with abroad array of health care needs, our Medicaid plans havedemonstrated that getting the right help when you need it isessential to better health. That’s why Aetna Medicaid plans includethe guidance and support needed to connect our members with theright coverage, resources, and care. We are focused on enhancingquality and population health outcomes while integrating CVS assetsto bring accessible healthcare to our members. Aetna Better Health of Louisiana is seeking an experience leaderwith vast operational knowledge of government programs such asMedicaid, Medicare and Dual Eligible for its state-wide managedMedicaid business in the role of Chief Operating Officer (COO). TheChief Operations Officer has the responsibility for overseeing allhigh-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 managedMedicaid business. The ideal leader is strategic, committed todeveloping employees, and relentlessly pursuing change that is bestfor the organization and its customers. The COO will be required tooversee the Medicare and Long-Term Care lines of business as well.

This position will assist the Plan CEO in the successful growth andperformance, including financial management of the Plan as well asinterface, collaborate and work cooperatively with corporate officefunctional leaders and centralized shared services businessdepartments. The COO is a valued leader in the organization and anextension of the CEO both within the Plan and externally with theregulatory agencies and other state department. You’ll make an impact by: Providing day-to-day leadership and management to a serviceorganization that mirrors the mission and core values of thecompany. Responsibility for driving the Plan to achieve and surpassperformance metrics, profitability, and business goals andobjectives. Leading and managing all operational activities ofvarious functional areas, beyond traditional service operations,which may include Claims, Encounters, Provider Services, DataManagement, Information Technology, Members Services, Network,Program Integrity, and Enrollment. Responsibility for employee compliance with, and measurementand effectiveness of all Business Standards of Practice includingProject Management and other processes internal and external. Providing timely, accurate, and complete reports on theoperating condition of the Plan. Developing policies and procedures for assigned areas andensures that other impacted areas, as appropriate, review new andchanged policies. Assisting the Plan leader in collaborative efforts related tothe development, communication and implementation of effectivegrowth strategies and processes. May be required to spearhead the implementation of newprograms, services, and preparation of bid and grantproposals. Collaborating with the Plan management team and others todevelop and implement action plans for the operationalinfrastructure of systems, processes, and personnel designed toaccommodate the rapid growth objectives of the organization. Assisting in defining marketing and advertising strategieswithin state guidelines. Participating in the development and implementation ofmarketing policies for the Plan and ensures their compliance withprogram regulations. Aiding in preparation and review of budgets and variancereports for assigned areas. Working cooperatively with Network Development team in thedevelopment of the provider network. Serving as a liaison with regulatory and other stateadministration agencies and communicates activity to CEO andreports back to Plan. Assuring compliance to and consistent application of law, rulesand regulations, company policies and procedures for all assignedareas. Ability to travel in-state; travel to various locationsincluding the office and to attend state meetings, etc., asrequired. Supporting CVS Health in attracting, retaining, and engaging adiverse and inclusive consumer-centric workforce that delivers onour purpose and reflects the communities in which we work, live,and serve. Required Qualifications The candidate will have a strong work ethic, be a self-starter, andbe able to be highly productive in a dynamic, collaborativeenvironment. This position offers broad exposure to all aspects ofthe company’s business, as well as significant interaction with allthe business leaders. The candidate will be expected to have thefollowing key attributes: 10+ years’ work experience that reflects a proven track recordof government programs such as Medicaid, Medicare, or Dual Eligibleincluding government affairs, legal, and an in-depth compliancebackground. Deep understanding of claims systems and processes, value-basedcontracts, TPL/COB, Pharmacy claims and how they impact total costof care, network contracting, call center management, encounterdata processing, and provider data. Must possess an understanding of how compliance and qualityprograms (NCQA and HEDIS) affect the Plan. Proficient on credentialing, provider relations (internal andexternal), network development to include adequacy and make up andhow that affects the provider experience and medical costs. High acumen on the marketing of Medicaid, the communications tomembers and providers, the involvement of community programs andthe interaction of SDOH (housing, employment, CHW, peerspecialists, and nutrition). Working knowledge of the interaction between physical andbehavioral health, and the outstanding characteristics ofbehavioral health in taking care of the Medicaid population. Ability to work collaboratively across many teams, prioritizedemands from those teams, synthesize information received, andgenerate meaningful conclusions.

Demonstrated leadership with relevant initiatives:

businessprocess optimization, enterprise business projectmanagement/consulting, financial strategic planning and analysis,mergers and acquisitions, and risk management. Ability to work a Hybrid Model (in office Tuesday / Wednesday /Thursday) out of the Kenner, LA office. This person must reside orbe willing to relocate to Louisiana. Demonstrated a commitment to diversity, equity, and inclusionthrough continuous development, modeling inclusive behaviors, andproactively managing bias.

Education:

Bachelor’s degree required; Master’s degreepreferred Pay Range The typical pay range for this role is: $131,500.00 – $303,195.00 This pay range represents the base hourly rate or base annualfull-time salary for all positions in the job grade within whichthis position falls. The actual base salary offer will depend on avariety of factors including experience, education, geography andother relevant factors. This position is eligible for a CVS Healthbonus, commission or short-term incentive program in addition tothe base pay range listed above. This position also includes anaward target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers,patients, members and communities we serve and we are committed tofostering a workplace where every colleague feels valued and thatthey belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay andbenefits – investing in the physical, emotional and financialwellness of our colleagues and their families to help them be thehealthiest they can be. In addition to our competitive wages, ourgreat benefits include: Affordable medical plan options, a 401(k) plan (includingmatching company contributions), and an employee stock purchaseplan. No-cost programs for all colleagues including wellnessscreenings, tobacco cessation and weight management programs,confidential counseling and financial coaching. Benefit solutions that address the different needs andpreferences of our colleagues including paid time off, flexiblework schedules, family leave, dependent care resources, colleagueassistance programs, tuition assistance, retiree medical access andmany other benefits depending on eligibility. For more information, visithttps://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will closeon: 05/30/2025 Qualified applicants with arrest or conviction records will beconsidered for employment in accordance with all federal, state andlocal laws. #J-18808-Ljbffr