Chief Operating Officer, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

131500.00 - 303195.00 USD / Year

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Job Description:

Chief Operating Officer for Aetna Better Health of Illinois (ABHIL), Aetna's Medicaid managed care plan. This role partners with the CEO to shape the Health Plan's strategic vision, policies, and operational objectives, including leading RFP readiness efforts. Oversees strategic and operational activities across key functional areas such as Claims, Provider Services, IT, Grievance & Appeals, Member Services, and Medical Management.

Job Responsibility:

Provide day-to-day leadership aligned with the company's mission and values
Drive performance to exceed metrics, profitability, and business goals
Lead operational activities across service operations and medical management, including Claims, Encounters, Provider Services, Data Management, IT, Member Services, Network, Program Integrity, and Enrollment
Ensure compliance with Business Standards of Practice and internal/external processes
Deliver timely, accurate reports on the Plan's operating condition
Develop and implement policies and procedures for assigned areas
Collaborate on growth strategies, operational infrastructure, and rapid expansion initiatives
Spearhead new programs, services, and bid/grant proposals as needed
Support marketing and advertising strategies within state guidelines
Prepare and review budgets and variance reports
Partner with Network Development to build provider networks
Serve as liaison with regulatory agencies and communicate updates to leadership
Ensure compliance with laws, regulations, and company policies
Travel in-state as required for meetings and site visits
Support the CEO in achieving growth and financial performance, including budget and P&L management
Collaborate with corporate functional leaders and shared services to drive operational excellence

Requirements:

10+ years of 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
5+ years of experience in executive leadership roles with proven track record of proficiency in the operational competencies noted
Must reside or be willing to relocate to Illinois
Demonstrated success with C-suite stakeholders
Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions
Experience developing and leading medical trend analysis and trend optimization initiatives
Experience evaluating subcontractors, developing value-based arrangements and business cases
Ability to conceive innovative ideas or solutions to meet client's requirements
Excellent communication and relationship management skills and be able to express thoughts in an organized and articulate manner
Ability to build 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 meaningful initiatives such as: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, risk management
Track record of success driving major initiatives across complex and matrixed organizations
Manage capital portfolio to support growth and provider/member incentives
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)
Bachelor's degree required

Nice to have:

Medicaid health plan leadership experience
Illinois healthcare landscape experience

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 20, 2025

Expiration:
December 18, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Chief Operating Officer