Vice President Clinical Operations

Vice President of Clinical Operations

At Blue Cross and Blue Shield of Minnesota, caring for our members and communities shapes how care is coordinated, how teams work together and how members experience healthcare. Reporting to the COO, the Vice President of Clinical Operations will provide strategic leadership and operational oversight for case management, utilization management, and behavioral health across all lines of business. This leader will lead teams supporting both physical and behavioral health, bringing together clinical expertise, operational excellence, and a commitment to delivering high-quality, cost-effective care. Working closely with the Health services leadership, medical directors, and case management and utilization management product teams, this leader will help shape effective programs, advance evidence-based practices, and ensure alignment with regulatory standards and enterprise priorities. This role offers an opportunity to influence how clinical operations and services evolve to better meet the needs of members and the community's Blue Cross serves. The VP will drive operational performance, establish meaningful measures of success, and champion improvements that strengthen clinical outcomes, efficiency and member satisfaction. To be successful in this role, we are looking for a leader who will foster a culture of collaboration, accountability, and continuous improvement, connecting people, programs, and priorities to create better experiences.

Oversee daily operations of clinical operations ensuring the proper allocation of resources to the highest priority deliverables

Collaborate with medical directors and other clinical teams to address complex cases and high-risk members; collaborate with cross functional departments to drive outcomes (claims, appeals, service, payment integrity, etc.

Develop and implement strategic plans for clinical operations.

Enhance operational efficiency and implement process improvements to enhance and optimize member engagement, quality of services and outcomes to support product development, operational productivity and execution.

Establishes and drives department goals and performance metrics that support the division and enterprise strategic plans.

Support enterprise-wide initiatives and effectively lead change. Provide strategic direction on how to support exceptional experience for internal and external customers and stakeholders.

Provide leadership and direction to the organizational leaders and staff.

Prepare and present reports on departmental performance to senior leadership and any auditing bodies.

Advocate for the needs and interests of members in clinical operations initiatives.

In partnership with the broader health services team, ensure adherence to clinical guidelines and evidence-based practices.

Establish and maintain alignment of departmental goals with organizational objectives and regulatory standards.

Maintain compliance with all relevant regulations, accreditation standards, and organizational policies.

Ensure associates and vendors have the appropriate structure, tools, resources, required to perform their job at the highest levels.

10+ years of related professional experience in a health plan or healthcare delivery system with 7+ years of people leadership. All relevant experience including work, education, transferable skills, and military experience will be considered.

7+ years of clinical adjacent experience

Strong knowledge of healthcare regulations, accreditation standards, and managed care principles.

Leadership : Excellent leadership and team management skills, including delegation, coaching, and mentoring skills to manage and empower staff to meet all required objectives.

Problem Solving: Strong analytical and problem-solving abilities, including the ability to balance competing priorities, develop and implement strategic initiatives, and resolve operational issues and conflicts.

Communication: Effective communication and interpersonal skills.

Collaboration: Ability to work collaboratively with diverse stakeholders including product development teams, and experience working across a highly matrixed environment.

Project Management : Skills in planning, change management, executing, and overseeing projects to ensure they are completed on time and within budget.

Technology Proficiency : Familiarity with healthcare IT systems, electronic health records (EHR), and data analytics tools.

Financial Acumen : Strong understanding of financial management, budgeting, and cost control in healthcare operations.

Innovation and Creativity: Ability to think creatively and implement innovative solutions to improve clinical operations processes with a focus on continuous improvement.

Risk Management : Skills in identifying, assessing, and mitigating risks in healthcare operations.

RN experience

Previous experience in managing vendor relationships

Education or equivalent experience in Business, Health Care Administration, or Public Health.

Hybrid

$300,000.00 - $317,500.00 - $335,000.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

And more

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.