Director, Commercial Clinical Operations- Care Management

Director, Commercial Clinical Operations – Care Management (THM Division)

Are you ready to lead a high-performing clinical team and shape the future of care management? We are seeking a Director of Commercial Clinical Operations to drive innovation, operational excellence, and measurable outcomes across diverse programs—including NICU, maternity, behavioral health, and complex care.

Why This Role Matters

As a key leader, you'll align clinical strategy with enterprise goals, optimize workflows, and ensure our programs deliver exceptional value to members and groups. You'll collaborate with Medical Directors, IT, Quality, and Account teams to create a seamless experience that supports health outcomes and client satisfaction.

What You'll Do

• Lead Strategic Initiatives: Design and execute care management strategies that improve quality, reduce costs, and enhance member engagement.
• Drive Operational Excellence: Oversee workflows, staff utilization, and program performance using data-driven insights and technology platforms.
• Engage Stakeholders: Partner with internal teams and external providers to resolve care coordination challenges and support RFP and finalist presentations.
• Innovate with Technology: Implement solutions that maximize workflow performance while leveraging dashboards, KPIs, and analytics to guide decisions and continuously improve outcomes.
• Build Culture: Foster engagement, transparency, and professional growth within a remote workforce, creating a "destination division" for clinical talent.

What We're Looking For

• Clinical Expertise: 10 years of clinical experience . In addition, a deep knowledge of care management across diverse populations (NICU, maternity, behavioral health, complex care, etc.) .
• Strategic Leadership: 5 years of leadership experience, aligning clinical programs with enterprise goals, driving innovation, and leading change. In addition, proven ability to align programs with enterprise priorities and lead change.
• Sales & Client-Facing Experience: Comfortable participating in RFP responses and finalist presentations.
• Technologically Savvy: Must be able to lead and execute a variety of technical implementations as our care management area becomes more focused on leveraging tech. Experience leading and executing at least one technical implementation. A plus for experience utilizing AI to improve processes and productivity
• Operational Acumen: Skilled in managing complex workflows and driving measurable results.
• Analytical Mindset: Comfortable interpreting performance data and using technology to inform decisions.
• Collaborative Communicator: Adept at working cross-functionally and engaging clients.
• Culture Builder: Committed to team development and transparent leadership.

Why Join Us?

You'll have the opportunity to influence enterprise strategy, innovate care delivery, and lead a team that makes a real difference in members' lives. If you're passionate about transforming clinical operations and creating exceptional outcomes, we want to hear from you

Job Responsibilities

• Strategic Planning: Devise strategies and plans for the clinical department, aligning them with company standards for excellent service and growth.
• Program Development & Design: Ensure programs are aligned with business and market needs, bringing value to organization and group accounts
• Collaboration with Stakeholders: Take active role in partnership with Claims, Customer & Provider Service, Sales and Account management teams; participating in finalist presentations as needed
• Compliance and Quality Assurance: Monitor adherence to legal guidelines, internal policies, and quality standards.
• Budget Oversight: Assume responsibility for budgeting and resource allocation within the clinical area.
• Operations: Oversee all organizational operations, ensuring smooth functioning.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment.
• Licensure: Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Experience

• 5 years – progressive leadership experience in care management, utilization management, clinical operations, or health plan operations required
• 10 years' experience in health care industry required
• 3 years' experience with a commercial health plan, preferred

Skills\Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Clinical Expertise: Solid understanding of clinical supervision, program management, and industry regulations.
• Process Improvement: Ability to utilize process improvement and/or Lean Six Sigma Methodologies
• Analytical: Strong business acumen with sound analytical skills

Registered Nurse with BSN highly preferred.

Managed care experience with Utilization Management and Care Management highly preferred.

Grade 14, BBOF, CAP Incentive Program

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.