Atlanta, Georgia, United States
Health Services Oversight Officer (Georgia)
Aetna Better Health (ABH) is Aetnas 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. Thats 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 Health Services Oversight Officer (HSOO) reports to the CEO and serves as an essential member of the leadership team and is a peer to the health plan COO, CFO and CMO. Must reside in Georgia.
The HSOO will assist the Plan CEO with growth and performance of the Health Plan. This role is essential to ensuring performance management and oversight of all clinical requirements of the contract. The HSOO interfaces, collaborates, and works cooperatively with corporate office functional leaders and centralized shared services business departments. This position leads all clinical interactions with the Georgia Department of Community Health (DCH) and is the single point of contact with numerous operational processes and work groups. This role must be able to travel in-state, and attend regulatory meetings in-person, also some travel to the office, as needed.
* Qualified candidates will have the drive, expertise, executive presence and business acumen to maintain operational excellence through a matrixed organizational structure with centralized medical management responsibilities. This is an individual-contributor role, that effectively influences and achieves results without having a direct reporting relationship with dependent partners.
* Must understand how quality programs such as NCQA and HEDIS affect the Plan.
* The ideal candidate will have subject matter expertise and experience in medical management operations, including UM, CM, Care program development and implementation, SDOH programs, Behavioral + Physical Health integration, and the importance of Quality integration at every level.
* Must have executive-level presentation skills and communicate complex concepts in an audience-appropriate manner within the organization, be comfortable meeting with external stakeholders, such as regulators, providers and associations as needed.
* Must have fluency in data analytics and be able to monitor performance results through reporting. This role drives the compliance processes needed to ensure we meet all standards in our Medicaid and Georgia contracts, such as monitoring report owners and the timely quality review of these reports.
* Develops and participates in presentations and consultations to existing and prospective customers.
* Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions).
* Participates in internal and external health industry development efforts.
* Develops, implements, and evaluates policies and procedures, which meet business needs (may cross multiple business functions).
* Implements and monitors business plan and oversee any implementations or business transitions impacting service operations.
* Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.
* Promotes a clear vision aligned with company values and direction; set specific challenging and achievable objectives and action plans; motivate others to balance customer needs and business success; challenge self and others to look to the future to create quality products, services, and solutions.
* Collaborates with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel.
* This is an individual contributor role and must have the ability to effectively influence and achieve results without having a direct reporting relationship with dependent partners.
The typical pay range for this role is:
Please 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.
* 10+ years experience in managed care, Medicaid (MMA+LTSS), CHIP and the Georgia regulatory environment.
* Ability to travel in-state is required, based on business needs.
* Demonstrated proficiency with personal computer, keyboard navigation and MS Office Suite applications.
* Demonstrated professional experience relevant to the Medicaid program and the state regulatory environment.
* Demonstrate a thorough understanding of managed care concepts and mechanisms.
* Masters degree preferred.
* Bachelors degree required.
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. 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.