Job Description

Chief Health Services Officer - Aetna Better Health of IL (Remote)

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.

Role Overview
Aetna Better Health of Illinois (ABHIL) is recruiting for an Executive Director, Health Services Operations, to be known at the health plan as the Chief Health Services Officer. This leader will report to the CEO and serve as a critical member of the health plan leadership team. This role is a peer to the health plan COO, CFO and CMO in ensuring our health plan health services function is optimally competitive in the IL Medicaid market. As the Chief Health Services Officer, you will be expected to maintain operational excellence through matrixed leadership and oversight of our centralized medical management functions, as well as be the health plan's subject matter expert in medical management operations, including Utilization Management, Care Management, Care program development and implementation, Social Determinants of Health programs, Behavioral Physical Health integration, and Quality integration at every level.

Key Responsibilities

• Ensuring the organization understands Illinois' needs, compliance benchmarks and timelines.
• Overseeing the analysis, management, execution and staffing for all health services operations impacting the health plan.
• Overseeing the activities of the Quality team to ensure maximal performance with HEDIS and accreditations.
• Serving as the SPOC on health services operations between the health plan and regulators.
• Representing the health plan as the health services SME for all Plan-specific RFP activity.
• Leading and partnering with the COO clinical program vendor implementations.
• Capturing and communicating to the health plan leaders all internal clinical initiatives.
• Identifying the compliance processes needed to ensure we meet all standards in our Medicaid.
• Presenting complex concepts to various levels of leadership within the organization.
• Serving as point of contact for all health services operations, meeting with external stakeholders as needed.
• Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive workforce.

Required Qualifications

• 10+ years of experience in medical management leadership roles.
• 5+ years of Medicaid experience, preferably in the State of Illinois.
• Experience with data analytics reporting and analysis.
• Experience presenting executive level presentations.
• Strong influencing skills to effectively work across a wide range of senior stakeholders.
• Extensive experience leading cross-functional initiatives.
• Experience working with varying levels of contacts.
• Demonstrated success in collaboration and execution across multiple departments.
• Strong decision-making, analytical and organizational skills.
• Ability to develop and execute strategic and tactical business plans.
• Demonstrate a commitment to diversity, equity, and inclusion.

Preferred Qualifications

• Registered Nurse, preferably in the state of IL.
• Illinois state resident.
• Interaction with the state regarding Medicaid programs.

Education

• Advanced degree preferred.
• Specialized training or relevant professional qualification will be considered.

Pay Range

The typical pay range for this role is: $100,000.00 - $231,540.00. 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.

For more detailed information on available benefits, please visit Benefits | CVS Health.

We anticipate the application window for this opening will close on: 12/31/2024.

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

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