Vice President Clinical Operations

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing.

If you are ready to make a difference, join us.

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.
• Ensure alignment of departmental goals with organizational objectives and regulatory standards.
• Ensure 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.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

• 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…