Job Description

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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Aetna 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.

Aetna Better Health of Illinois (ABHIL) is seeking an experienced leader with deep operational expertise in Medicaid Managed Care to serve as Chief Operating Officer (COO) for its statewide managed Medicaid business.

The COO will partner with the CEO to shape the Health Plan’s strategic vision, policies, and operational objectives, including leading RFP readiness efforts. This role oversees strategic and operational activities across key functional areas such as Claims, Provider Services, IT, Grievance & Appeals, Member Services, and Medical Management (Quality, Network, Compliance, Health Equity, Medical Directors, Utilization Management, Vendor Management). Responsibilities include driving productivity, fostering an inclusive and diverse culture, and ensuring organizational outcomes are achieved. The COO will also manage the Long-Term Care line of business.

Key Responsibilities

• 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.

Additional Expectations

• 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.
• Possess strong knowledge of claims systems, TPL/COB, pharmacy claims, call center management, and encounter data processing.
• Understand provider data, credentialing, relations, contracting, and value-based arrangements.
• Ensure compliance with state contracts and regulations; maintain awareness of government affairs and legal requirements.
• Demonstrate expertise in Medicaid marketing, member /provider communications, community programs, and SDOH initiatives (housing, employment, CHWs, peer specialists, nutrition).
• Maintain working knowledge of physical and behavioral health integration and its impact on Medicaid populations.
• Act as a trusted extension of the CEO internally and externally with regulatory agencies and stakeholders.

The COO will lead business operations, drive employee productivity, and cultivate a thriving, inclusive culture. This role requires strong leadership, relationship-building, and talent development skills to ensure organizational success.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 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).

Preferred Experience

• Medicaid health plan leadership experience.
• Illinois healthcare landscape experience.

Education:

Bachelor's degree required.

Pay Range

The Typical Pay Range For This Role Is

$131,500.00 - $303,195.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit

We anticipate the application window for this opening will close on: 12/18/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.

If you have questions about this posting, please contact support@lensa.com

Job Tags

Hourly pay, Full time, Contract work, Temporary work, Work experience placement, For subcontractor, Local area, Relocation, Flexible hours,

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