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Position Summary
At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.
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Aetna is recruiting for an Executive Director, Medicaid Provider Experience Standardization who is responsible for ensuring the variations that currently exist across multiple Medicaid Health plans specific to provider contracting, credentialing, provider onboarding, loading and maintenance are standardized and documented, with strong data entry control points to drive alignment and transparency with the Network Operations Team and the Medicaid Health Plans. This leader will develop and define the standard workflows to use for new market implementations and expansions, as well as define the process to transition each Health Plan from current state to the new standard. This leader is responsible for owning the organizational Medicaid Provider Experience Standardization strategy, end-to-end execution of the strategy with collaboration of cross functional partners. This leader must exhibit strong communication, executive presence, and influence skills.
You'll make an impact by:
- Leading the development and execution of process mapping, workflows, audit, and controls for core Network processes such as Intake, Credentialing, Provider Data Loading, Rosters, Non-Par Loads, Provider Terminations, Market Expansions, and Implementations, and Deeming.
- Designing a uniformed review and control process for provider data loads and update requests / submission to ensure strong data entry control points and help drive alignment with the Network Operations Team and the Health Plans.
- Enhancing the bulk load process to load and update provider data within QNXT and streamlining the process to complete the spreadsheet inputs efficiently.
- Implementing a PRMS mailbox specific for VBS providers to ensure requests are resolved appropriately by Analysts that are familiar with VBS requirements.
- Advancing a PRMS dashboard in which health plans have access to track the progress / status of their requests and requests submitted by providers.
- Developing a formal process and capacity to conduct periodic provider outreach to ensure accuracy of provider data and directories.
- Developing a formal process to conduct PCR audits and ProData audits to identify trends and determine opportunities for training / education.
- Developing a formal process for member reassignments or member / provider communication when members' PCPs are terminated.
- Reviewing active prior authorizations and informing the UM/CM departments prior to the completion of the termination to ensure continuity of care.
- Leveraging the Provider Assessment Report to proactively identify and address provider data issues.
- Creating and running controls such as SQL queries and analytics at regular intervals to proactively identify and address provider data issues.
- Recommending prioritization of technology investment pipeline to support migration to standard workflows.
- Defining a plan to align capabilities and processes across lines of business.
- Sets direction of the strategic business plan and translates into vision for staff/others.
- Detail Orientation: sets priorities and executes strategy for the organization. Leads development of solutions with high complexity and risk with business area implications.
- Curiosity: collaborates with business partners to understand their strategy, problems, and goals; works with senior leaders to identify opportunities to implement solutions.
- 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.
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:
- 15+ years of experience in strategy, data, operations, business analysis, with demonstrated business impact.
- Proven track record managing complex and cross functional projects and/or programs that successfully resulted in material business impacts.
- Experience working with Medicaid products and understanding the relationships between payer and provider (ex: Network, Claims).
- Experience working with provider data in QNXT.
- Proven track record of delivering results while building high performing teams. Must have highly developed leadership skills to build high-performing teams, manage and develop talent, influence, and impact a broad set of stakeholders, engage, and inspire others, and lead by example.
- Successful engagement with senior leaders in distributed organizations on projects that require alignment, prioritization, and synthesis.
- Beacon for Culture: demonstrated experience building and enhancing organizational accountability, trust, and partnership.
- Experience positively influencing stakeholders to support key projects/programs to ensure positive outcomes that deliver on results.
- Communication: confident, succinct verbal communicator; produces effective written communication with little input from senior leader.
- Six Sigma Black Belt certification is a plus.
- Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday) from any Aetna Hub location.
- Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Bachelor's degree, or an equivalent combination of formal education and experience. Master's degree in quantitative field or MBA strongly preferred.
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 annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 10/04/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.