Aetna Senior Director, Medicaid Operations, COO in Richmond, Virginia

Req ID: 37921BR

POSITION SUMMARY

Responsible for increasing member and provider satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. 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 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 business departments.

Fundamental Components:

Provides day-to-day leadership and management to a service organization that mirrors the mission and core values of the company. Interfaces with corporate office staff as required.

Responsible for driving the Plan to achieve and surpass performance metrics, profitability, and business goals and objectives.

Responsible for employee compliance with, and measurement and effectiveness of all Business Standards of Practice including Project Management and other processes internal and external. Provides timely, accurate, and complete reports on the operating condition of the Plan. Develops policies and procedures for assigned areas. Ensuring that other impacted areas, as appropriate, review new and changed policies.

Assists the CEO 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.

Collaborates 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.

Assists in defining marketing and advertising strategies within State guidelines. Participates in the development and implementation of marketing policies for the Plan, and ensures their compliance with program regulations.

Provides assistance in preparation and review of budgets and variance reports for assigned areas.

Works cooperatively with Network Development team in the development of the provider network. Acts as client-care officer through direct contact with all stakeholders. Serves as a liaison with regulatory and other state administration agencies and communicates activity to CEO and reports back to Plan.

Communicates, Motivates and leads a high performance management team. Attract, recruit, train, develop, coach, and retain staff. Fosters a success-oriented, accountable environment within the Plan.

Ensures that performance evaluations and compensation decisions for employees are not influenced by the financial outcomes of claims decisions.

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

Prompt response with a sense of urgency/priority to customer requests.

BACKGROUND/EXPERIENCE desired:

Ability to work closely with client service, operations, and investment personnel

Ability to work collaboratively across many teams, prioritize demands from those team, synthesize information received, and generate meaningful conclusions.

Ability to conceive innovative ideas or solutions to meet clients requirements.

Proven leadership and negotiation skills.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

REQUIRED SKILLS

Leadership/Engaging and Developing People/MASTERY

Leadership/Driving a Culture of Compliance/MASTERY

Leadership/Developing and Executing Strategy/MASTERY

DESIRED SKILLS

Finance/Profit and Quality Vigilance/MASTERY

General Business/Turning Data into Information/MASTERY

Service/Creating a Differentiated Service Experience/MASTERY

ADDITIONAL JOB INFORMATION

Dynamic Plan growth across all lines of business: Chip, Medicaid, Duals, DSNP, and MLTSS

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Customer Service