Medical Management Operations Director

5 days ago

Eagan, Minnesota, United States Blue Cross Blue Shield of Minnesota Full time

About Blue Cross Blue Shield of Minnesota

We're a leading health care brand with 2.5 million members, committed to reinventing health care to improve health for our members and the community.

The Director of Medical Management Operations is responsible for overseeing and managing the daily operations of Medical Management teams, including coordination of the Peer Review process, relationship owner and oversight of outside vendors, performance reporting and monitoring across all Care Management functions, including productivity and quality metrics, oversight of automation opportunities and business process optimization across all of Care Management, and clinical learning and development.

This role ensures that the operations team delivers high-quality, timely, and cost-effective services to our clients and partners to enable successful deployment of product strategies and support delivery of stated outcomes.

A Day In The Life:

Oversight of obligations and coordinates and facilitates the MD peer review process, including oversight of the annual peer review budget, ensuring compliance with quality standards and contractual obligations, and troubleshooting day to day operational issues.

Build and maintain strong relationships with outside vendors, including clinical staff augmentation vendors, Independent Review Organizations, technology vendors, and utilization management vendors.

The team will partner closely with Business Partnerships & Negotiations on contracting. This role will ensure service level agreements (SLA) are being upheld.

Track and analyze the productivity and performance of clinical teams and provide feedback and coaching to clinical managers to improve efficiency and quality.

Prepare and present reports and dashboards on key metrics and indicators, such as turnaround time, accuracy, volume, and client satisfaction.

Oversee automation efforts and business process optimization across all Care Management functions to support operational efficiency and quality.

Develop and implement clinical learning and development programs and initiatives, such as training, mentoring, and certification, to enhance the skills and competencies of the clinical team.

Requirements:

7+ years of related professional experience, with 3+ years of management experience. All relevant experience, including work, education, transferable skills, and military experience, will be considered.

Minimum of 5 years of experience in operations, preferably clinical and in a remote setting.

Strong knowledge of clinical processes, regulatory requirements, experience with continuous improvement, and oversight of budgets.

Excellent communication, interpersonal, and leadership skills.

Proficient in Microsoft Office, Google Suite, and other relevant software and tools.

Ability to work independently and collaboratively in a fast-paced and dynamic environment.

Equal Opportunity Employer:

Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity.

All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to .

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

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

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