Lead Business Consultant

Job Description
Aetna Better Health of Texas (ABHTX) is searching for a Sr Director, Health Services Operations, to be known at the health plan as Health Services Oversight Officer. The role will report to the CEO and serves as a critical member of the health plan leadership team. This role is a peer to the health plan COO, CFO and CMO in ensuring our health plan health services function is optimally competitive in the Texas Medicaid and CHIP markets.
The right candidate will have the drive, expertise, executive presence, and business acumen to maintain operational excellence through matrixed leadership and oversight of our medical management functions. This is an individual contributor role and the right candidate will know how to effectively lead teams without having a direct reporting relationship.
Subject Matter Expertise will be demonstrated by the successful depth of experience in medical management operations, including UM, CM, Service Coordination, and care program development and implementation, SDOH programs, Behavioral + Physical Health integration, and the importance of Quality integration at every level.
Your professional experience will demonstrate relevance to the Medicaid program and the Texas regulatory environment. Just as significantly, you are able to demonstrate a thorough understanding of managed care concepts and mechanisms.
You possess executive-level presentation skills and can communicate complex concepts in an audience-appropriate manner within the organization, are comfortable meeting with external stakeholders, such as providers, as needed; and understand this role as the accountable contact for all health services operations. Core job duties:
1. For all health services operations issues relevant to the health plan, this role is the leader representing the health plan to shared services and the enterprise broadly. You will ensure the organization understands Texas needs, compliance benchmarks and timelines. You will work closely with the organization to ensure the organization delivers on these needs.
2. This role, through effective oversight, will ensure successful communication, analysis, management, execution, monitoring and staffing for all health services operations impacting the health plan.
3. This role serves as the SPOC on health services operations (CM, UM, all related programs) between the health plan and the regulators. This role represents the health plan as the health services SME for all external and regulatory stakeholders related to CM, UM, and Service Coordination functions. This role represents the health plan as the health services SME for all Plan-specific RFP activity.
4. This role identifies the compliance processes needed to ensure we meet all standards in our Medicaid & CHIP Contracts, such as monitoring report owners and the timely quality review of these reports and works with functional owners and Compliance to ensure overall compliance of processes.

Required Qualifications
7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment
Must have fluency in data analytics

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment
Must have fluency in data analytics

Masters degree preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.