CVS Health · 5 hours ago

Chief Health Services Officer - Aetna Better Health of IL (Remote)

Illinois, United States

Full-time

Remote

Director/Executive

$100K/yr - $232K/yr

10+ years exp

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Responsibilities

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medical management leadershipMedicaid experienceData analyticsExecutive presentationsStrategic business plansRegistered Nurse

Required

10+ years of experience in medical management leadership roles including leadership within managed care organizations

5+ 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