Operations Manager, State Program Maryland Medicaid

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.

As our Medicaid footprint expands, operational complexity has grown significantly. Key functions—enrollment, provider data management, member services, claims operations management. This senior leader will identify process gaps, design improvements, and drive implementation, where there is a member/provider dissatisfaction specially around provider data accuracy and provider directory, they will work with departments to understand root cause issues and implement gap closures and correcting root cause.

• Lead initiatives to improve provider and member data accuracy including improvement in provider directory.

• Lead and direct several orphaned processes and workflows.

• Conduct root cause analysis of operational issues and design cross-functional solutions.

• Serve as a liaison between business operations and technology teams to align automation and system improvements.

• Support operational readiness for regulatory changes.

• Reduce inefficiencies in several processes.

• Plans, implements, and manages operations programs and strategies.

• Supports, develops, and validates compliance with operations policies, procedures, and regulations. Reviews, manages, and drives operations efficiency, quality, and financial performance.

• Support business direction and develops, implements, and oversees operational models to meet the business requirements of Aetna Better Health.

• Verifies improvements and operations are evaluated based on appropriate quantitative and qualitative measures.

• Verifies optimized operations, including training and educating staff from different departments on COMAR and ABHMD contract.

• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (e.g., member services center, enrollment, technology).

• Informs and advises the COO regarding state’s current trends, problems, and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth.

• Owns end-to-end process improvement: definition of need, project plans, status updates, reporting and achieving results.

• Identifies and resolves technical, operational, and organizational problems inside and outside Aetna Better Health.

• Validates all operational activities conform to contract compliance for all programs.

• Understands and manages the state requirements and relationship related to operations.

• Directs others to resolve business problems that affect multiple functions or disciplines.

• Evaluates outcomes based on qualitative and quantitative measures and adjusts accordingly.

• 5+ years of experience as an operational leader.

• 3+ years of professional experience in Medicaid.

• Experience related to publicly funded government health care programs (e.g., Medicaid, Medicare, or state health care programs for the uninsured).

• Operations experience in Medicaid, Medicare, or government health care program administration.

• Solid problem solving skills and business planning skills within a matrix environment.

• Demonstrated experience advising IT resources related to enterprise platform initiatives and provide direction on platform migration.

• Bachelor’s degree or equivalent work experience preferred.

The typical pay range for this role is:

$82,940.00 - $

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…