Introduction to Our Company and IndustryIn the rapidly evolving healthcare landscape, our company stands at the forefront, committed to delivering exceptional service and innovative solutions to our clients. As a leader in the managed Medicaid business, we are dedicated to improving the lives of our members by providing high-quality, patient-centered care. Our mission is built on a foundation of integrity, respect, and a passion for excellence. We are now seeking an experienced and skilled Remote Operations Leader to join our team, working closely with Aetna to drive success in our Medicaid business.Job OverviewThis is a unique opportunity for a seasoned professional to lead our operational efforts, ensuring the delivery of outstanding results and exceptional customer experience. As a Remote Operations Leader for Aetna Medicaid Business , you will be responsible for overseeing all significant functional activities across various operational areas, including but not limited to Claims, Provider Services, Information Technology, Complaints and Appeals, Member Services, and Clinical Management. Your leadership will be instrumental in driving our business forward, achieving performance metrics, and ensuring compliance with regulatory requirements.Key Responsibilities• Provide daily leadership and management to a service organization that reflects the mission and values of our company.• Drive the plan to achieve and exceed performance metrics, profit, and business objectives and targets.• Lead and manage all operational activities of various functional areas, beyond traditional service operations, which may include Claims, Experiences, Provider Services, Data Management, Information Technology, and more.• Ensure employee compliance with, and measurement and effectiveness of all Business Guidelines of Practice, including Project Management and other cycles, both internal and external.• Deliver timely, accurate, and comprehensive reports on the operating condition of the plan.• Develop policies and strategies for assigned areas and ensures that other affected areas, as appropriate, review new and changed policies.• Collaborate with the plan leadership team and others to develop and implement action plans for the operational infrastructure of systems, processes, and staff intended to accommodate the rapid growth objectives of the company.• Participate in the development and implementation of marketing strategies for the plan and ensures their compliance with program guidelines.• Support the development and review of budgets and change reports for assigned areas.• Work cooperatively with the Organization Development team in the development of the provider network.• Serve as a contact with regulatory and other state agency offices and communicates activity to the CEO and reports back to the plan.• Ensure compliance with and consistent application of regulation, rules, and guidelines, company policies and procedures for all assigned areas.• Ability to travel in-state; travel to different locations including the office and to attend state meetings, etc., as required.Essential QualificationsTo be successful in this role, you will need:• A strong and diverse skill set in relevant areas, including operational management, leadership, and compliance.• Proven experience in Medicaid, Medicare, or Dual Eligible programs, including government contracts, legal, and an in-depth compliance background.• A deep understanding of claims systems and processes, value-based contracts, TPL/COB, Pharmacy claims, and their impact on total cost of care.• Knowledge of network contracting, call center management, experience data processing, and provider data.• Understanding of how compliance and quality programs (NCQA and HEDIS) impact the plan.• Proficiency in credentialing, provider relations (internal and external), network development, and how that influences the provider experience and clinical costs.• High familiarity with the marketing of Medicaid, communications to members and providers, the inclusion of community programs, and the coordination of SDOH (housing, employment, CHW, peer specialists, and nutrition).• Working knowledge of the interplay between physical and behavioral health and the unique characteristics of behavioral health in managing the Medicaid population.• Ability to work collaboratively across multiple teams, prioritize requests from those teams, blend information received, and produce meaningful conclusions.• Demonstrated leadership with relevant initiatives: business process optimization, project business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, and risk management.• Exhibit a commitment to diversity, equity, and inclusion through continuous development, demonstrating inclusive behaviors, and proactively managing bias.Preferred QualificationsWhile not required, the following qualifications are highly desirable:• Advanced degree in Business Administration, Healthcare Management, or a related field.• Professional certifications in healthcare management or a related field.• Experience working in a remote or hybrid environment, with a proven ability to manage and lead teams virtually.• Strong technical skills, including proficiency in Microsoft Office and experience with claims systems and operational software.Career Growth Opportunities and Learning BenefitsAt our company, we are committed to the growth and development of our employees. As a Remote Operations Leader for Aetna Medicaid Business , you will have access to a range of training and development opportunities, including:• Leadership development programs, designed to enhance your skills and knowledge in operational management and leadership.• Professional certification programs, to support your career advancement and professional growth.• Networking opportunities, to connect with other professionals in the industry and build relationships that can help you achieve your career goals.• Performance management and feedback, to help you identify areas for improvement and develop a plan to achieve your goals.Work Environment and Company CultureOur company culture is built on a foundation of respect, integrity, and a passion for excellence. We believe in creating a work environment that is inclusive, supportive, and empowering, where employees can thrive and grow. As a Remote Operations Leader for Aetna Medicaid Business , you will be part of a dynamic and collaborative team, working together to achieve our mission and vision.Compensation, Perks, and BenefitsWe offer a competitive compensation package, including a salary of $30 per hour, comprehensive benefits, and a range of perks and incentives, including:• Health, dental, and vision insurance, to support your physical and mental well-being.• 401(k) plan, to help you save for your retirement.• Paid time off, to give you the flexibility to balance your work and personal life.• Professional development opportunities, to support your career growth and advancement.• Recognition and reward programs, to recognize and reward your contributions to our company.ConclusionIf you are a motivated and experienced professional, looking for a new challenge and opportunity to grow, we encourage you to apply for this exciting role. As a Remote Operations Leader for Aetna Medicaid Business , you will be part of a dynamic and collaborative team, working together to achieve our mission and vision. Don't miss this opportunity to join our team and make a difference in the lives of our members. !Apply for this job