Vice President Clinical Operations

BCBSM, Inc.; United States; Hybride; USD 300 000 - 335 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision insurance

401k

PTO and VPTO

Résumé du poste

Blue Cross and Blue Shield of Minnesota is seeking a Vice President of Clinical Operations to provide strategic leadership and operational oversight for case management, utilization management, and behavioral health across lines of business. The VP will lead teams, shape programs, and drive improvements in outcomes, efficiency, and member satisfaction.

The role reports to the COO, requires strong regulatory knowledge and analytics, and supports both physical and behavioral health with a hybrid

Qualifications

• 10+ years in a health plan or healthcare delivery system with 7+ years of people leadership.
• 7+ years of clinical adjacent experience.
• Strong knowledge of healthcare regulations and managed care principles.
• Excellent leadership and delegation, coaching, and mentoring skills.
• Strong analytical and problem-solving abilities with strategic initiatives.
• Effective communication and interpersonal skills.
• Ability to work with diverse, matrixed stakeholders and cross-functional teams.
• Experience planning, change management, and executing complex projects.
• Familiarity with healthcare IT systems, EHR, and data analytics tools.
• Understanding of financial management, budgeting, and cost control in healthcare.

Responsabilités

• Oversee daily operations of clinical operations and resource allocation.
• Collaborate with medical directors and clinical teams on complex cases and high-risk members.
• Develop and implement strategic plans for clinical operations.
• Improve processes to enhance member engagement, quality of services, and outcomes.
• Establish department goals and performance metrics aligned with plans.
• Provide strategic direction to ensure exceptional experience for customers and stakeholders.
• Lead organizational leaders and staff; prepare performance reports for leadership and auditors.
• Ensure adherence to clinical guidelines and regulatory standards.
• Manage structure, tools, and resources for associates and vendors.

Connaissances

Leadership & people management

Healthcare regulations

Strategic planning

Operational excellence

Budgeting & cost control

Analytics & problem solving

Communication & collaboration

Change management

EHR systems familiarity

Cross-functional collaboration

Formation

Bachelor's degree in Healthcare Administration

Outils

EHR systems

Health analytics tools

Description du poste

About Blue Cross and Blue Shield of Minnesota

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.

The Impact You’ll Have

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.

What You’ll Do

• 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.

How You’ll Do It

• 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.

Required Skills & Experience

• 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.
• Excellent leadership and team management skills, including delegation, coaching, and mentoring skills to manage and empower staff to meet all required objectives.
• Strong analytical and problem‑solving abilities, including the ability to balance competing priorities, develop and implement strategic initiatives, and resolve operational issues and conflicts.
• Effective communication and interpersonal skills.
• Ability to work collaboratively with diverse stakeholders including product development teams, and experience working across a highly matrixed environment.
• Skills in planning, change management, executing, and overseeing projects to ensure they are completed on time and within budget.
• Familiarity with healthcare IT systems, electronic health records (EHR), and data analytics tools.
• Strong understanding of financial management, budgeting, and cost control in healthcare operations.
• Ability to think creatively and implement innovative solutions to improve clinical operations processes with a focus on continuous improvement.
• Skills in identifying, assessing, and mitigating risks in healthcare operations.

Preferred Skills & Experience

• RN experience.
• Previous experience in managing vendor relationships.
• Education or equivalent experience in Business, Health Care Administration, or Public Health.

Role Designation

Hybrid Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full‑time onsite.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in‑person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in‑person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits

• $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. To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

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 Aff irmative 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. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail]. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.

Chartered in 1933 as Minnesota’s first health plan, this company is one of the most recognized and trusted healthcare brands in the world. It has more members, the largest network of doctors, and more products and services than any other health plan in Minnesota. Headquartered in Eagan, Minnesota.