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Nurse Careers

At Aetna, a CVS Health Company, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.

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Success Profile

What makes a successful nurse? Here are the traits we are looking for:

  • Collaborative
  • Deadline-oriented
  • Organized
  • Problem Solver
  • Results Driven
  • Technology Savvy
  • Adaptable
  • Compassionate
  • Detail Oriented
  • Flexible
  • Good Listener
  • Open Minded
  • Responsible
  • Team Player

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Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Chief Operating Officer - Aetna Better Health of California

Primary Location: San Diego, California
Additional Locations: CA-San Diego
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Description:
The Senior Director, Medicaid Operations is responsible for leading and running all hands-on operational aspects and activities of various functional areas within the Plan which may include: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services and Business Information and Management Analysis. Partners with the Plan leaders in the successful growth and performance of the Plan. The Senior Director, Medicaid Operations also interfaces, collaborates and works cooperatively with corporate office functional leaders and centralized business departments.

Fundamental Components:

(*) Serves as a key member of the leadership team in the locally-based Medicaid managed care plan. Provides strategic and tactical leadership to network management, claims, provider services, complaints and appeals, member services, reporting, and implementation of new programs.

(*) Establishes a clear vision aligned with company goals and values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to build quality products, services, and solutions.

(*) Develops, monitors, and reviews performance reports and service performance trends and recommends specific actions or remedies as necessary.

(*) Develops and maintains strong collaborative relationships within operations as well as with medical management, quality, and compliance.

(*) Develops, trains, evaluates, and coaches staff to provide cost effective claim processing and claim and customer service while ensuring that quality standards are met.

(*) Assesses individual and team performance on a regular basis and provides candid and timely developmental feedback; monitors training plans and ensures training needs are met.

(*) Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals; builds a cohesive team that works well together.

(*) Creates and maintains tools, job aids, and training materials to help employees in their efforts to resolve issues and improve their relationship with customers.

(*) Collects, analyzes and reports on operations information in support of process, systems, and policy redesign.

(*) Effectively applies and implements Aetna HR policies and practices, i.e. FML/EML, Attendance, Code of Conduct, and Disciplinary Guidelines. Effectively leads cross-functional projects that support the business strategy.



Background Experience:
(*) 10+ years work experience that reflects a consistent record of proficiency in the competencies noted.

(*) Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.

(*) Ability to conceive innovative ideas or solutions to meet client's requirements.

(*) Excellent communication and relationship management skills.

(*) Express thoughts in an organized and articulate manner.

(*) Listen very effectively and build a climate of trust and respect with prospective and existing clients and the consulting community.

(*) Ability to work closely with client service, operations, and investment personnel.

(*) Validated leadership and negotiation skills.

(*) Proven leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, strategic planning, and risk management.

(*) Recent and related managed health care experience.

(*) Bachelor's degree required; Master's degree preferred.

(*) Experience with MediCal and California IPAs preferred.

(*) Experience with QNXT preferred.

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.



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