AVP Chief of Clinical Operations, Quality & Strategy

Blue Cross and Blue Shield of Kansas; Topeka (KS); Hybrid; USD 170,000 - 260,000; Full time

Benefits offered by this job

Incentive pay program

6 weeks paid parental leave

Fertility/Adoption assistance

2 weeks paid caregiver leave

Health & fitness benefits

Job summary

A major health insurance provider in Topeka, Kansas, is seeking an AVP Chief of Clinical Operations, Quality & Strategy. This strategic role involves leading Utilization Management and clinical initiatives to enhance patient care and outcomes. The successful candidate will possess a medical degree and extensive leadership experience, specifically in managed care. This position promotes a hybrid work environment while providing vital contributions to population health. Join us to make a difference in the healthcare landscape.

Qualifications

• Minimum of 10 years of progressive, relevant clinical experience in care delivery or managed care.
• Minimum of 5 years in a senior leadership role, preferably in the health insurance industry.
• Experience in utilization management leadership or closely related area for at least 3 years.

Responsibilities

• Transform Utilization Management to improve evidence-based healthcare delivery.
• Lead and mentor a high-performing clinical team for professional growth.
• Ensure strategic alignment of clinical programs and resource optimization.
• Provide fiscal oversight for clinical programs, including budget management.
• Develop innovative clinical programs to promote whole-person care.
• Develop innovative clinical programs promoting whole‑person care.
• Oversee prior authorization, medical necessity reviews, and post‑service payment integrity.
• Use data analytics to drive continuous performance improvement.
• Identify and mitigate risks; drive change management across the enterprise.
• Maintain compliance with state/federal regulations and accreditation standards.
• Represent the organization as a clinical strategy thought leader.

Skills

Population Health

Change Management

Analytical Skills

Stakeholder Engagement

Regulatory Compliance

Change Management

Stakeholder Engagement

Executive Communication

Performance Management

Healthcare Quality

Education

Medical Degree (MD or DO)

Bachelor's degree in medicine, nursing, or a related clinical field

Tools

Health Analytics platforms

Job description

AVP Chief of Clinical Operations, Quality & Strategy

Join to apply for the AVP Chief of Clinical Operations, Quality & Strategy role at Blue Cross and Blue Shield of Kansas

Blue Cross and Blue Shield of Kansas is looking to add to our Medical Affairs teams and has a new opportunity for an AVP Chief of Clinical Operations, Quality & Strategy. This position provides strategic leadership and oversight for Utilization Management and other key clinical initiatives. This position leverages evidence‑based methodologies and enterprise data assets to drive continuous quality improvement and advance population health outcomes. A catalyst for enterprise‑wide transformation, this leader champions strategic initiatives that enhance clinical programs through collaboration and cross‑functional partnership. This position reports to Senior Vice President, Chief Medical Officer.

This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well‑being of Kansans.
• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Trust: Work for one of the most trusted companies in Kansas.

What you’ll do

• Provide clinical leadership to transform Utilization Management by promoting cost‑effective, evidence‑based healthcare delivery.
• Lead, mentor, and develop a high‑performing clinical team, fostering collaboration, accountability, and professional growth. Build succession plans and talent strategies to support long‑term organizational success.
• Ensure strategic alignment of clinical programs, benefit design, and internal resources to optimize member outcomes and alignment of goals across the enterprise.
• Provide fiscal oversight for clinical programs, including budget development, monitoring, and alignment with enterprise affordability goals. Ensure financial stewardship and accountability for cost containment and ROI on strategic initiatives.
• Lead high‑impact clinical projects that support affordability and corporate strategic projects and programs to deliver results on all strategic initiatives.
• Develop and integrate innovative clinical programs, promoting whole‑person care and dismantling silos.
• Oversee clinical operations including prior authorization, medical necessity reviews, and post‑service payment integrity/claims review to develop operational excellence.
• Use evidence‑based practices and analytics to drive continuous performance improvement.
• Identify and mitigate operational and strategic risks within clinical programs. Champion change management initiatives to ensure successful adoption of new processes, technologies, and cultural shifts across the enterprise.
• Maintain compliance with state/federal regulations and accreditation standards.
• Represent the organization as a clinical strategy thought leader at industry conferences, regulatory meetings, and client engagements. Serve as a trusted advisor to external stakeholders and promote the organization’s vision for clinical transformation.

What you need

• Medical Degree (MD or DO) or equivalent clinical doctorate required; Bachelor’s degree in medicine, nursing, or a related clinical field also required.
• Minimum of 10 years of progressive, relevant clinical experience in care delivery, managed care, or population health, with a strong working knowledge of healthcare operations – required.
• Minimum 5 years of experience in a senior leadership role, preferably within the health insurance industry – required.
• Minimum of 3 years of experience in utilization management leadership or a closely related area – required.
• Demonstrated success in leading enterprise‑wide clinical initiatives and operational transformation.

Knowledge/Skills/Abilities

• Deep understanding of Population Health and Managed Care operations.
• Strong analytical skills, including ROI analysis and performance improvement.
• Expertise in regulatory compliance and accreditation.
• Experience in clinical innovation and change management.
• Excellent communication and stakeholder engagement skills.
• Strong Data Analytics and Health Analytics skills and oversight.
• Experience in leading with a data‑driven approach, key performance indicators and well versed with performance management expertise.
• Ability to champion the design and deployment of innovative program initiatives, translating strategic objectives into actionable workflows tailored to new digital platforms.
• Directed cross‑functional teams in the rollout of new technology platforms, creating scalable processes and training protocols to support adoption and long‑term success.
• Proven ability to lead organizational change and manage risk in complex healthcare environments.
• Experience presenting to executive leadership and external stakeholders, including regulatory bodies and industry forums.

Bonus if you have

• Advanced degree preferred (e.g., MPH, MBA).
• Professional certification in Healthcare Quality, Executive Leadership, or Project Management preferred.

Base compensation is only one component of your competitive Total Rewards package

• Incentive pay program (EPIP)
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• Health & fitness benefits, discounts and resources