Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

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.

** This position is fully remote. Eligible candidates can live anywhere in the US, Illinois resident preferred.

Aetna Better Health of Illinois (ABHIL) is recruiting for an Executive Director, Health Services Operations, to be known at the health plan as the Chief Health Services Officer. This leader will report to the CEO and serve as a critical member of the health plan leadership team. This role is a peer to the health plan COO, CFO and CMO in ensuring our health plan health services function is optimally competitive in the IL Medicaid market. As the Chief Health Services Officer, you will be expected to maintain operational excellence through matrixed leadership and oversight of our centralized medical management functions, as well as be the health plan's subject matter expert in medical management operations, including Utilization Management, Care Management, Care program development and implementation, Social Determinants of Health programs, Behavioral Physical Health integration, and Quality integration at every level.

You’ll make an impact by:

Ensuring the organization understands Illinois' needs, compliance benchmarks and timelines. You will work closely with the organization to ensure the organization delivers on these needs. Representing the health plan to shared services and the enterprise broadly.Overseeing the analysis, management, execution and staffing for all health services operations impacting the health plan.Overseeing the plan to a detailed and supportive oversight of the activities of the Quality team to ensure maximal performance with HEDIS and accreditations.Serving as the SPOC on health services operations (CM, UM, all related programs) between the health plan and regulators. This role represents the health plan as the health services SME for all external and regulatory stakeholders.Representing the health plan as the health services SME for all Plan-specific RFP activity.Leading and partnering with the COO clinical program vendor implementations and maintaining an oversight relationship with all external clinical program stakeholders.Capturing and communicating to the health plan leaders all internal (AMA, Aetna, CVS) clinical initiatives to ensure the Plan maintains a cohesive clinical strategy appropriate to our market competitiveness and growth goals.Identifying the compliance processes needed to ensure we meet all standards in our Medicaid, such as monitoring report owners and the timely quality review of these reports and works with COO and Compliance to ensure overall compliance of processes.Presenting complex concepts to various levels of leadership within the organization.Serving as point of contact for all health services operations, meet with external stakeholders, such as providers, as needed.Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
 

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.

The candidate will be expected to have the following key attributes:

10+ years of experience in medical management leadership roles including leadership within managed care organizations5+ years of Medicaid experience, preferably in the State of Illinois.Experience with data analytics reporting and analysis used to help serve managed care populations.Experience presenting executive level presentations to various internal and external audiences.Strong influencing skills to effectively work across a wide range of senior stakeholders to drive alignment and results.Extensive experience leading cross-functional initiatives and driving innovation.Experience working with varying levels of contacts, including executive leadership, department leadership, capability enablers and external state officials.Demonstrated success in the areas of collaboration, teamwork, and execution across multiple departments to deliver results.Strong decision-making, analytical and organizational skills.Ability to develop and execute strategic and tactical business plans.Ability to exercise sound business judgment to achieve proper balance between objectives and stakeholder engagement.Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias

Preferred Qualifications

Registered Nurse, preferably in the state of ILIllinois state residentInteraction with the state with respect to Medicaid programs, contract requirements, reporting, and deliverables

Education

Advanced degree preferredSpecialized training or relevant professional qualification will be considered

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.