Vice President of Care Management Operations

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 Will Have

The VP of Care Management Operations will lead the operational management and performance of clinical management (case, utilization, and behavioral) for all lines of business, as well as the oversight of the clinical teams that may support both physical and behavior health. In this role, you will be responsible for ensuring the delivery of high-quality, cost-effective care management and utilization management services that align with the organization's strategies, goals, and regulatory requirements. Additionally, the VP Care Management Operations will partner closely on program design with health services leadership and with the case and utilization management product teams to optimize the value of the respective programs including outcomes and member satisfaction.

Your Responsibilities

• Develop and implement strategic plans for care management operations.

• Enhance operational efficiency to optimize member engagement/outcomes and maximize operational productivity.

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

• Ensure alignment of departmental goals with organizational objectives and regulatory standards.

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

• 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.

• Oversee daily operations of care management. Ensure the proper allocation of resources to the highest priority deliverables; ensure associates and vendors have the appropriate structure, tools, resources, required to perform their job at the highest levels.

• Implement process improvements to enhance efficiency and quality of services; supports product development and execution.

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

• 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.

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

• Advocate for the needs and interests of members in care management initiatives.

Required Skills & Experience

• Accepting this position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment, and Restrictive Covenants Agreement as a condition of employment.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

• 10 years of related professional experience in a health plan or health care delivery system with 7 years in a leadership role. 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, 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 care management processes with a focus on continuous improvement.

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

Preferred Skills & Experience

• RN experience

• Previous experience in managing vendor relationships

• 3 years leading in a senior leadership role

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

Compensation and Benefits:

Pay Range: $275,000.00 - $302,500.00 - $330,000.00 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 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.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.