Director, Utilization Management & Clinical Excellence

BCBSM; Eagan (MN); On-site; USD 180,000 - 280,000; Full time

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a Director of Clinical Operations in Eagan, MN. You will provide strategic and clinical leadership for Utilization Management, strengthening decision-making, operational excellence, affordability, and positive member outcomes.

You will lead a high-impact team, oversee vendor operations, and collaborate with Product, data, and technology to drive performance and value for members and customers.

Responsibilities

• Direct clinical and operational leadership of Utilization Management, focusing on quality, affordability, compliance, and positive member outcomes.
• Advance UM practices to support sound clinical decision-making, operational performance, and continuous improvement.
• Develop people leaders who translate strategy into clear priorities and guide teams through change.
• Oversee vendor and delegated clinical operations, ensuring accountability and alignment with UM standards and performance objectives.
• Collaborate across clinical, medical, Product, data, and technology teams to resolve complex problems and align priorities.
• Leverage performance data and benchmarks to identify trends, set priorities, and guide decisions.

Job description

Blue Cross and Blue Shield of Minnesota is seeking a Director of Clinical Operations in Eagan, MN. You will provide strategic and clinical leadership for Utilization Management, strengthening decision-making, operational excellence, affordability, and positive member outcomes.

You will lead a high-impact team, oversee vendor operations, and collaborate with Product, data, and technology to drive performance and value for members and customers.