COO, Aetna Better Health of Oklahoma

Job DescriptionAetna 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.The Chief Operating Officer has the responsibility for overseeing all high-level operational activities of various functional areas, beyond traditional service operations, which may include: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, and Medical Management for our state-wide managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentlessly pursuing change that is best for the organization and its customers. The COO will be required to oversee the Medicare and Long-Term Care lines of business as well. This position will assist the Plan CEO in the successful growth and performance, including financial management of the Plan as well as interface, collaborate and work cooperatively with corporate office functional leaders and centralized shared services business departments. This position requires a deep understanding of claims systems and processes, value-based contracts, TPL/COB, Pharmacy claims and how they impact total cost of care, network contracting, call center management, encounter data processing, and provider data. Qualified candidates should have knowledge of government programs such as Medicaid, Medicare, or Dual Eligible including government affairs, legal, and an in-depth compliance background. Must possess an understanding of how compliance and quality programs (NCQA and HEDIS) affect the Plan. Needs to be proficient on credentialing, provider relations (internal and external), network development to include adequacy and make up and how that affects the provider experience and medical costs. Needs a high acumen on the marketing of Medicaid, the communications to members and providers, the involvement of community programs and the interaction of SDOH (housing, employment, CHW, peer specialists, and nutrition). Should have a working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population. The COO is a valued leader in the organization and an extension of the CEO both within the Plan and externally with the regulatory agencies and other state department.LOCATION - Must live in Oklahoma or be willing to relocate to OklahomaKey responsibilities: 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 Plan leader 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. Documented follow through/closure. Assists as assigned or required in performing other duties, assignments and/or responsibilities.Pay RangeThe typical pay range for this role is:Minimum: 131,500Maximum: 289,300Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications 10+ years' work experience that reflects a proven track record of proficiency in the operational competencies noted. Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions. Ability to conceive innovative ideas or solutions to meet clients' requirements. Excellent communication and relationship management skills. Ability to express thoughts in an organized and articulate manner. Promotes and builds a climate of trust and respect with regulators, external stakeholders, as well as colleagues, peers, and our internal growth partners. Proven leadership and negotiation skills. Demonstrated leadership with relevant initiatives: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, and risk management. Must have recent and related managed health care experience. Ability to travel in-state; travel to various locations including the office and to attend state meetings, etc., as required.Preferred Qualifications Advanced DegreeEducation Bachelor's DegreeBusiness OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-10-04