Senior Director of Health Services - Utilization Management

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 Senior Director of Health Services, Utilization Management is responsible for the design, strategic planning, evolution, and value delivery of specific Health Services programs and products. The position is accountable for delivering high value programs and products to BCBSMN customers and for assuring members receive high quality and appropriate clinical care in a timely and cost-effective manner. This role will collaborate closely with leaders across all lines of business and across multiple business units to ensure programs and products meet the needs of customers and members we serve.

This role will also partner closely with operational leaders to ensure accountability for efficient and effective execution of programs and products.

• Leads, either directly or via their team, the ideation, design, implementation, measurement, and ongoing evaluation of specific programs and products.

• Manages and maintains accountability for the delivery of overall value of specific programs and products.

• In partnership with Operations, ensures programs and products are achieving desired outcomes and meet all applicable regulatory and compliance standards as well as accreditation requirements.

• Partners closely with the internal stakeholders and product leaders to ensure strategies are aligned to achieve and maximize value.

• Works with Commercial, Medicare, and Medicaid leadership to ensure programs and products meet the unique needs of their specific member populations and positions BCBSMN as a leader in the market.

• Establishes department goals and performance metrics that support divisional and enterprise strategic plans. Ensures that the right systems, processes, and measurement/reporting are in place to demonstrate the value and effectiveness of programs and products to customers.

• Manage relationships with and ensures the accountability of external partners / vendors that provide key services that enable program / product outcomes.

• Partners with operations to enhance operational efficiency to optimize and maximize staff and external partner productivity and value.

• Educates internal staff and contracted providers on the general and unique needs of populations being served, to ensure adherence to BCBSMNs benefits, medical, and reimbursement policies.

• Supports enterprise initiatives to enhance the member experience and improve both the quality of care delivered and total cost of care.

• Represents BCBS to a variety of external stakeholders including provider organizations, customers, advocacy groups and government entities as needed.

• Other duties as assigned

• Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement policies, and maintenance of strategic vendor relationships that drive product value.

• This role will partner closely with operations leadership to ensure efficient execution of UM product as well as with the payment integrity team to maximize the value and efficiency of programs and products within UM and payment integrity.

• This role will also partner closely with network leadership to ensure products and programs work in synergy with the network strategy to drive maximal value.

• Establishes rigorous performance measurement and management to maximize value and ensure staff is optimally deployed, and that products and programs achieve their intended outcomes and customer commitments.

• Ensures talent is in place to improve affordability and member health.

• Serves as a role model and coach/mentor for ongoing leadership and staff development.

• Build a culture of engagement, teamwork, psychological safety, and collaboration across the enterprise.

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

• 8+ years of related professional experience, with 5+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• 5+ years in an applicable leadership position in a health plan or health care delivery serving customers, members, or patients.

• Ability to establish a comprehensive strategic plan for programs and products.

• Demonstrated ability to lead people, create high performing teams and develop talent.

• Ability to organize and manage multiple priorities and budgets.

• Excellent communication and presentation skills to…