Chief Operations Officer, Aetna Better Health of Kentucky
About the role
Aetna Better Health is Aetna’s Medicaid managed care plan. We are seeking an experienced leader with extensive knowledge of government programs such as Medicaid, Medicare, and Dual Eligible to serve as the Chief Operating Officer (COO) for our state-wide managed Medicaid business in Kentucky.
Responsibilities
Partner with the Plan CEO to drive successful growth, operational excellence, and overall business performance.
Oversee financial management of the health plan, including budget accountability, revenue target achievement, and P&L performance.
Collaborate with corporate functional leaders and centralized shared services teams to drive operational effectiveness and business results.
Provide leadership and oversight across core operational areas, including: Claims systems and processing, Third-Party Liability (TPL) and Coordination of Benefits (COB), Pharmacy claims operations and their impact on total cost of care, Call center operations and performance, and Encounter data management and processing.
Lead and support provider operations activities, including: Provider data management, Credentialing, Provider relations, Network development and contracting, and Value-based care contracting and performance initiatives.
Drive strategies that enhance provider experience while managing medical costs and improving operational outcomes.
Ensure compliance with all applicable state contracts, regulations, executive orders, and healthcare industry requirements.
Partner with Government Affairs and Legal teams to address regulatory, legislative, and compliance-related matters.
Build and maintain strong relationships with community-based advocacy organizations and industry stakeholders.
Oversee communications and engagement strategies for members and providers.
Support and promote community-based programs that address Social Determinants of Health (SDOH), including housing, employment, Community Health Workers (CHWs), Peer support specialists, and nutrition and food access initiatives.
Apply expertise in the integration of physical and behavioral healthcare, with a strong understanding of the unique needs of the Medicaid population.
Represent the organization externally with regulatory agencies, state departments, community partners, and other key stakeholders.
Act as a trusted executive leader and extension of the CEO, providing strategic leadership both internally and externally.
Qualifications
10+ years of work experience reflecting a proven track record of government programs such as Medicaid, Medicare, or Dual Eligible plans.
5+ years of 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 clients' requirements.
Excellent communication and relationship management skills and being 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, risk management.
Track record of success driving major initiatives across complex and matrixed organizations.
Manage capital portfolio to support growth and provider/member incentives.
Recent and related managed health care experience.
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.
Preferred Qualifications
Ability to leverage data (including but not limited to claims, clinical, operations, and survey-based) to identify emerging trends/needs and develop market priorities accordingly.
Education
Bachelor's degree required.
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.