Chief Operating Officer, Aetna Better Health of Oklahoma

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.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 Oklahoma 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. 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 department.You'll make an impact by:

• Providing expansive operational knowledge to include claims systems and processes, TPL/COB, Pharmacy claims and how they impact total cost of care, call center management, and encounter data processing.
• Possessing a detailed understanding of provider data, credentialing, provider relations, network development and contracting, value-based contracts and how these impact provider experience and medical costs.
• Assuring compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas.
• Providing a high acumen on the marketing of development and implementation of marketing policies for the Plan and ensures their compliance with program regulations for communications to members and providers, the involvement of community programs and the interaction of SDOH (including but not limited to housing, employment, CHWs, peer specialists, and nutrition).
• Working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population.
• Overseeing business operations performance and employee productivity, building and maintaining our highly inclusive and diverse culture, ensuring team members thrive, and organizational outcomes are met. Leading people, building/maintaining relationships while driving talent and culture development.
• Providing day-to-day leadership and management to a service organization that mirrors the mission and core values of the company.
• Responsibility for employee compliance with, and measurement and effectiveness of all Business Standards of Practice including Project Management and other processes internal and external.
• Providing timely, accurate, and complete reports on the operating condition of the Plan. Aiding in preparation and review of budgets and variance reports for assigned areas.
• Developing policies and procedures for assigned areas and ensures that other impacted areas, as appropriate, 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.
• May be required to spearhead the implementation of new programs, services, and preparation of bid and grant proposals.
• Collaborating with the Plan management team and others to develop and implement action plans for the operational infrastructure of systems, processes, and personnel designed to accommodate the rapid growth objectives of the organization.
• Working cooperatively with Network Development team in the development of the provider network.
• Serving as a liaison with regulatory and other state administration agencies and communicates activity to CEO and reports back to Plan.
• 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 that delivers on our purpose and reflects the communities in which we work, live, and serve.

• 10+ years of work experience that reflects a proven track record of government programs such as Medicaid, Medicare, or Dual Eligible including government affairs, legal, and an in-depth compliance background.
• 5+ years of work 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 client's requirements.
• Excellent communication and relationship management skills and be able to express thoughts in an organized and articulate manner
• Ability to build a climate of trust and respect with regulators, external stakeholders, as well as colleagues, peers, and our internal growth partners.
• Proven leadership and negotiation skills.
• Demonstrated leadership with meaningful initiatives such as: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, and risk management.
• Track record of success driving major initiatives across complex and matrixed organizations.
• Must possess an understanding of how compliance and quality programs (NCQA and HEDIS) affect the Plan.
• Proficient on credentialing, provider relations (internal and external), network development to include adequacy and make up and how that affects the provider experience and medical costs.
• High acumen on the marketing of Medicaid, the communications to members and providers, the involvement of community programs and the interaction of SDOH (housing, employment, CHW, peer specialists, and nutrition).
• Working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population.
• Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.
• Ability to work a Hybrid Model (in office Tuesday / Wednesday / Thursday) out of the Oklahoma City, OK office. This person must reside or be willing to relocate to Oklahoma.
• Demonstrated a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.