Experience Inc. Jobs

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 Louisiana 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 Chief Operations Officer has the responsibility for overseeing all high-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 managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentlessly pursuing change that is best for the organization and its customers. The COO will be required to oversee the Medicare and Long-Term Care lines of business as well. 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 day-to-day leadership and management to a service organization that mirrors the mission and core values of the company.

• Responsibility for driving the Plan to achieve and surpass performance metrics, profitability, and business goals and objectives. Leading and managing all operational activities of various functional areas, beyond traditional service operations, which may include Claims, Encounters, Provider Services, Data Management, Information Technology, Members Services, Network, Program Integrity, and Enrollment.

• 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.

• 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.

• Assisting in defining marketing and advertising strategies within state guidelines.

• Participating in the development and implementation of marketing policies for the Plan and ensures their compliance with program regulations.

• Aiding in preparation and review of budgets and variance reports for assigned areas.

• 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.

• Assuring compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas.

• 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.

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’ 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.

• Deep understanding of claims systems and processes, value-based contracts, TPL/COB, Pharmacy claims and how they impact total cost of care, network contracting, call center management, encounter data processing, and provider data.

• 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.

• Demonstrated leadership with relevant initiatives: business process optimization, enterprise business project management/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 or be willing to relocate to Louisiana.

• Demonstrated a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.

Education: Bachelor's degree required; Master's degree 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 (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 01/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.