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Chief Operating Officer, Medicaid – Michigan

CVS Health

CVS Health is a health care innovation company. Together, we are are helping people on their path to better health.

Job Description
Aetna Better Health of Michigan is seeking an experienced Chief Operating Officer (COO) for its managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentless in pursuing change that is best for the organization and its customers. On a daily basis, the COO is responsible for overseeing all operational activities of various Plan functional areas through direct and indirect reporting lines to: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Configuration, Contracting, Enrollment and supporting functional areas. The COO will assist the Plan CEO in the successful growth and performance of the Plan. The COO also interfaces, collaborates, and works cooperatively with corporate office functional leaders and centralized shared services business departments. The individual needs a deep understanding of claims, value-based contracts, TPL/COB, and Pharmacy. The ideal candidate will have extensive knowledge of government programs such as Medicaid, Medicare, or Dual Eligible including government affairs, legal, and an in-depth compliance background. The individual must understand how compliance and quality programs (NCQA and HEDIS) affect the Plan. The candidate needs to be proficient on credentialing, provider relations (internal and external), network development (ensuring adequacy and mix) and how that affects the provider experience. The candidate will need a high acumen on the marketing of Medicaid, effective member and provider communications, the mission imperative on community programs and the interaction of SDOH (housing, employment, CHW, peer specialists, and nutrition). They should have a working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population. 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 Michigan Department of Health and Human Services (MDHHS) and other state departments.

Required Qualifications
– 10+ years work experience that reflects a proven track record of proficiency in the Medicaid managed care operational competencies noted.
– Proven ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.
– Proven ability to conceive innovative ideas or solutions to meet client’s requirements.
– The individual must be able to build a climate of trust and respect with regulators, prospective and existing clients, and our internal growth partners such as health services, service operations, and finance/actuarial personnel.
– Proven leadership and negotiation skills – must have demonstrated leadership with meaningful initiatives such as: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, risk management.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
See above.

Education
Bachelor’s degree or equivalent.

Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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Chief Operating Officer, Medicaid – Michigan

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CVS Health

CVS Health is a health care innovation company. Together, we are are helping people on their path to better health.

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