Executive Director, Chief Operations Officer - Aetna Health of Maryland

Chief Operations Officer (COO)

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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.

Aetna Better Health of Maryland is seeking an experienced leader with vast operational knowledge of Medicaid for its state-wide managed Medicaid business in the role of Chief Operations Officer (COO). The COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts.

The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Network, Compliance, Health Equity, Medical Directors, Utilization Management, Vendor Management). These activities may include colleague productivity, building and maintaining a highly inclusive and diverse culture as well as ensuring team members thrive and organizational outcomes are met.

Major responsibilities include:

• 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.
• Serve as a key advocate with internal stakeholders, state regulators, policymakers, and other external partners.
• Build and maintain strong relationships with community-based advocacy organizations and industry stakeholders.
• Oversee communications and engagement strategies for members and…