Operations Manager, State Program Maryland Medicaid

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Senior Manager, Operational Efficiency – Medicaid Operations 

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. 

Key Responsibilities 

• 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  

• Supports 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 problem