Chief Operating Officer

Chief Operating Officer

Requirements

• 10+ years’ work experience that reflects a proven track record of government programs such as Medicaid, Medicare, or Dual Eligible including government affairs, legal, and an in-depth compliance background.
• 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.
• Must possess an understanding of how compliance and quality programs (NCQA and HEDIS) affect the Plan.
• 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.
• 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).
• Working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population.
• Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.
• Demonstrated leadership with relevant initiatives: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, and risk management.
• Ability to work a Hybrid Model (in office Tuesday / Wednesday / Thursday) out of the Kenner, LA office. This person must reside or be willing to relocate to Louisiana.
• Demonstrated a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.

Responsibilities

• Providing day-to-day leadership and management to a service organization that mirrors the mission and core values of the company.
• Responsibility for driving the Plan to achieve and surpass performance metrics, profitability, and business goals and objectives. Leading and managing all operational activities of various functional areas, beyond traditional service operations, which may include Claims, Encounters, Provider Services, Data Management, Information Technology, Members Services, Network, Program Integrity, and Enrollment.
• Responsibility for employee compliance with, and measurement and effectiveness of all Business Standards of Practice including Project Management and other processes internal and external.
• Providing timely, accurate, and complete reports on the operating condition of the Plan.
• Developing policies and procedures for assigned areas and ensures that other impacted areas, as appropriate, review new and changed policies.
• Assisting 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.
• Collaborating 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.
• Assisting in defining marketing and advertising strategies within state guidelines.
• Participating in the development and implementation of marketing policies for the Plan and ensures their compliance with program regulations.
• Aiding in preparation and review of budgets and variance reports for assigned areas.
• Working cooperatively with Network Development team in the development of the provider network.
• Serving as a liaison with regulatory and other state administration agencies and communicates activity to CEO and reports back to Plan.
• Assuring compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas.
• Ability to travel in-state; travel to various locations including the office and to attend state meetings, etc., as required.
• 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.

Preferred Qualifications

• Master’s degree preferred