Chief Operating Officer, Aetna Better Health of Illinois

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