Director, Clinical Performance and Strategy

Blue Cross of Idaho (BCI) has an exciting opportunity for a seasoned Director to lead our Healthcare Operations division with a focus on strategy, data, regulatory alignment, and transformation. This role will drive cross-functional process improvements, innovation, and enterprise-wide initiatives that enhance care delivery, operational efficiency, and member experience. The Director will lead strategic planning, data analytics, regulatory strategy, and innovation initiatives across Healthcare Operations. This includes large-scale transformational projects focused on building core business, technology, and industry expertise to deliver world-class healthcare solutions.

This position reports to the VP Healthcare Operations. This role has the ability to be based in a hybrid work location and/or work remotely within a mutually acceptable location. Would need to be in office for in person events. #LI-Remote; #LI-Hybrid

To be considered for this role, you have:

Required Experience:

A minimum of 10 years leading enterprise-wide strategic, process, or change initiatives in healthcare.

• Proven track record of implementing end-to-end strategy, tools, training, and communication plans.

• Experience managing large-scale healthcare projects ($500k–$2M+).

• Background as a Practitioner, Mentor, or Thought Leader in healthcare transformation.

• Practical application of methodologies such as Lean, Six Sigma, Agile.

• Experience leading teams of analysts and cross-functional project teams.

Required Education:

• Bachelor's Degree (with preference in Healthcare, Engineering, Process Design, Performance Technology, Information Technology/Computer Science or Business Administration); or equivalent work experience (Two years' work experience is equivalent to one year college)

We'd also love it if you had:

• Master of Business Administration (MBA) or related field.

• Certifications in Process Improvement (Lean, Six Sigma, Agile), Change Management, or Project Management.

• Experience in healthcare payer or insurance industries.

• Proven success in matrixed environments and agile development teams.

Having the following knowledge, skills and abilities will be the foundation of your success:

Knowledge of:

• Strategic planning methodologies and performance reporting.

• Data governance, analytics platforms, and dashboard development.

• Regulatory frameworks including CMS, NCQA, and state-level compliance.

• Medicare STAR Rating methodology, including performance domains, data sources, and improvement strategies.

• Innovation models in healthcare delivery and payer operations.

• Change management principles and methods.

• Portfolio, program, and project management tools.

• General medical and agile terminology.

Skills:

• Strong interpersonal, negotiation, and conflict resolution skills.

• Collaborative leadership and partnership-building across departments.

• Thought leadership in continuous improvement and transformation.

• Exceptional written and verbal communication.

• Strategic foresight and organizational awareness.

• Resilience, adaptability, and problem-solving.

• Proficiency in Microsoft Office Suite.

Ability to:

• Lead strategic planning and transformation initiatives.

• Drive data-informed decisions and performance improvement.

• Align operations with regulatory requirements and audit readiness.

• Pilot and scale innovative healthcare solutions.

• Influence enterprise-wide adoption of best practices.

• Coach and mentor leaders and staff across the organization.

Leadership Expectations

• Provide vision and direction for strategic initiatives.

• Act as a key advisor to business partners and executive sponsors.

• Promote a culture of innovation, diversity, and continuous learning.

• Communicate strategic goals and outcomes effectively.

• Develop and manage departmental budgets and performance metrics.

• Lead change management efforts and mitigate organizational risk.

• Foster teamwork, collaboration, and a respectful workplace.

In this role, we will ask you to:

• Develop and execute strategic plans aligned with Healthcare Operations goals.

• Lead transformation initiatives including care model redesign, digital health integration, and value-based care strategies.

• Oversee data strategy, analytics, and performance dashboards to inform decision-making.

• Ensure regulatory alignment with CMS, NCQA, and state-level requirements.

• Champion innovation in care delivery, member engagement, and operational processes.

• Collaborate with cross-functional teams including clinical, IT, finance, and compliance.

• Establish a culture of continuous improvement and operational excellence.

• Act as a thought partner to the VP of Healthcare Operations and senior leadership.

• Perform other duties as requested by the VP of Healthcare Operations

As of the date of this posting, a good faith estimate of the current pay range is $132,000 to $198,000. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data.

At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.