Aetna Director, Medicaid Operations - Maryland Heath Plan - 48302BR in Linthicum, Maryland

Req ID: 48302BR

Aetna Better Health of Maryland is hiring Director, Medicaid Operations.


The Director, Medicaid Operations maintains oversight of functions in multiple service departments, including claim payments, claim rework, member or provider inquiries, billing, enrollment, accounts receivable, and/or implementation services. Executes strategic and operational plans in support of business segment customer services objectives and initiatives. Sets business area priorities, allocates resources and develops plans for multiple related teams. Ensures all critical service metrics and operational results are achieved. Leads multiple managers, highly specialized professional staff or significant outsourced operations.

Fundamental Components:

(*) Oversees the operations of multiple service departments handling a customer service function, which may include: claims, member services, provider services, community outreach, grievance and appeals, enrollment, accounts receivable and other health plan service areas.

(*) Oversees operating systems including policies and procedures, operating structure, and information flow across multiple service centers.

(*) Directs implementation of service standards for each location to ensure delivery of quality-focused, consistent cost effective service and administration.

(*) Analyzes operational practices for effectiveness and practicality, while creating a culture which is innovative in its approach to solutions.

(*) Establishes a clear vision aligned with company values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs, budgets, and business success.

(*) Develops an organization that attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals; builds a cohesive team that works well together and across other business segment functions.

(*) Effectively and proactively manages to budget, analyzing and acting upon financial variances from plan by identifying additional cost saving strategies.

(*) Leads and builds high performance teams across units by providing leadership, mentoring and coaching in achieving understanding of the voice of the customer.

(*) Accountable for leading staff in accordance with Aetna's standards of leadership excellence.

(*)Monitors and evaluates service center operational plans ensuring customer service standards are maintained during facility shutdowns (anticipated or unanticipated) and during business activity transfers between locations.

(*) Coordinates major plan modifications necessitated by unanticipated business or technology developments.


(*) 8+ years experience in health care management and operations management;

(*) 5+ years previous management experience leading functional areas such as claims, IT, Member Services, Provider Services, Community Outreach and Call Center Operations. Previous managed care, healthcare and customer service experience required.

(*) Bachelor's degree in a closely-related field or equivalent combination of education and experience. Masters degree preferred.

(*) Advanced proficiency with MS Office Suite applications is required.


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


Functional - Administration / Operations/Management: < 25 employees/4-6 Years

Functional - Customer Service/Customer service - production environment/7-10 Years

Functional - Network Management/Provider relations/7-10 Years

Functional - Communications/Member communications/7-10 Years

Functional - Communications/Provider communications/7-10 Years


Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User

Technical - Desktop Tools/Microsoft Word/7-10 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/7-10 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End User


-Qualified candidates will possess multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes. -Demonstrated and proven strong leadership, coaching and mentoring skills and previous experience hiring and managing larger high performance teams. -Experienced working with all levels of management and external stakeholders. Exceptional communication skills, verbal, written and presentation is required. -Must have strong operations focus and strategic vision. -Demonstrated ability to respond to customer requests appropriately and timely. -Demonstrated ability to read, analyze and interpret complex documents and manage performance metrics; ability to understand and present complex financial reports -Must be forward thinking and able to conceive new and innovative ideas or solutions. -Negotiates, communicates, writes, advises and counsels on extremely complex and/or sensitive matters. -Experience with the design, development and administration of managed health care programs (Medicaid and other Government programs) preferred. Demonstrate successful experience in cross functional team implementation, projects, etc. -Excellent human relations and interpersonal relationship skills. -Demonstrated ability to collaborate; fostering strong partnerships while working cross-functionally to execute business deliverables.

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.

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.


Job Function: Customer Service