Description: Aetna Better Health of Virginia is seeking a dynamic, ambitious Chief Operating Officer (COO) for its 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. On a daily basis, the COO is responsible for leading and managing all hands-on operational aspects and activities of various functional areas within the Plan which may include: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Medical Management and the Medicare and Long Term Care lines of business. Assists 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.
Deep understanding of claims, value-based contracts, TPL/COB, Pharmacy claims and how they impact total cost of care. They need to have knowledge of Medicaid, Medicare, Dual Eligibles, government affairs, legal, and an in-depth compliance background. Must understand how compliance and quality programs (NCQA and HEDIS) affect the Plan. They need to be 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. They need a 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). 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 DMAS and other state departments. Background Experience: 15+ years work experience that reflects a proven track record of proficiency in the competencies noted. 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. Express thoughts in an organized and articulate manner. Listen very effectively and build a climate of trust and respect with prospective and existing clients and the consulting community. Ability to work closely with client service, operations, and finance/actuarial personnel. Proven leadership and negotiation skills. Demonstrated leadership with meaningful initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, risk management. Recent and related managed health care experience. Bachelor's degree required; Master's degree preferred.
What are we looking for in our colleagues? We seek fresh ideas, fresh opinions, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. Our high-energy and client-focused colleagues work hard every single day to make a positive difference in the lives of our customers. Required Skills: Finance - Delivering Profit and Performance, General Business - Consulting for Solutions, Leadership - Creating Accountability, Leadership - Driving a Culture of Compliance, Leadership - Driving Strategic and Organizational Agility, Leadership - Engaging and Developing People, Technology - Leveraging Technology Desired Skills: General Business - Applying Reasoned Judgment, General Business - Ensuring Project Discipline, Leadership - Driving Change, Leadership - Engaging and Developing People, Technology - Promoting Emerging Technology Functional Skills: Actuarial - Financial actuarial analysis, Administration / Operation - Budget coordinator, Administration / Operation - Management: > 25 employees, Clinical / Medical - General Management, Clinical / Medical - Marketing, Clinical / Medical - Network management, Communication - Member communications, Finance - Financial analysis, General Management - Project management (non-IT), Government Relation - State, Leadership - Act as company spokesperson to external constituents, Leadership - Lead a complex or multifunctional organization Technology Experience: Aetna Application - QNXT Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.