About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. How Is This Role Important to Our Work? The Director of Case Management is responsible for the delivery of case management services to enrolled BCBS MN Medicare Advantage and Commercial (FI/SI) plans. They are also responsible for ensuring compliance with federal and state regulations, contractual obligations, and quality standards. They lead and supervise a team of case managers who coordinate care for members which may include complex medical, behavioral and social needs. They develop and implement policies and procedures, performance metrics, and quality improvement initiatives for the case management department. They collaborate with internal and external stakeholders, such as providers, community organizations, and government agencies, to facilitate access to appropriate and cost effective services. They provide analysis and reports of significant utilization trends, patterns, and impacts to resources. They consult and collaborate with teams to gain alignment and improved access and utilization of effective and appropriate benefits and services. The director ensures that business objectives are aligned, business strategies are delivered/executed and financial (cost of care/administrative), and compliance and quality objectives are met. A Day in the Life: Provide strategic direction, leadership, and operations oversight to programs and staff to optimize efficiency and effectiveness of Case Management operations, deliver positive health outcomes, meet/exceed performance guarantees and increase stakeholder satisfaction. Collaborate with strategic partners and external customers to deliver market differentiating health management strategies that align to corporate and divisional priorities. Direct operational readiness and regulatory/accreditation compliance via formal processes such as policy and procedure, program descriptions, auditing, training, and metric monitoring and management. Lead the evaluation of program performance based on analysis of data and market requirements to identify and act on opportunities to enhance and improve. Direct the creation, prioritization, and execution of approved business cases. Lead the creation and communication of program performance value through formal and informal presentations, dashboards, RFP content, client meetings and committee participation. Serves as a change leader supporting, communicating and taking personal ownership of operational strategy and success criteria. Leverage vendor partners and build a network among external market influencers, including regulatory bodies and Blue Plan resources, to bring new insights and solutions that increase the value delivered to all stakeholders and to communicate existing value to the market. Build and foster an environment where Medical Management teams work effectively and efficiently. Leads and directs a high performing team including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the appropriate training. Conducts performance evaluation and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control. Nice to Have: Advanced degree in business, finance or healthcare administration. Health plan program leadership experience. Current and unrestricted Minnesota licensure for one or more of the following; Registered nurse Medical Case and/or Disease Management, Registered nurse Behavioral or Chemical Health Case and/or Disease Management, Registered nurse or licensed independent mental health practitioner Behavioral or Chemical Health Utilization Management Registered nurse or licensed independent mental health practitioner, Medical doctor. Required Skills and Experiences: Accepting this director level 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 3+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered. Demonstrate maturity, flexibility and capacity to navigate a complex structure with strong critical thinking,, problem solving, and conflict resolution skills. Outstanding facilitation, written and oral communications skills to convey complex ideas simply, through written reports and presentation materials. Strong leadership skills with the ability to generate ideas, support and commitment from constituents. Proven team building, mentoring and coaching skills with experience leading professional staff. Strong business acumen and understanding of cross-industry business practices, market and competitive drivers. Proven success driving and delivering results in a complex cross functional environment. Knowledge of healthcare payer industry and business processes. Ability to see across the enterprise and identify potential risks and issues that impact other ongoing work efforts. Strong collaboration and partnering skills at all levels. Ability to work effectively with cross functional groups, fostering teamwork with a dedication to quality. Knowledge an ability to understand business strategy, including deep expertise with the accountability of scope and relate that strategy to program execution business knowledge across multiple functional areas. Strategic thinking and critical decision making at an enterprise level. Ability to thrive in ambiguity and adapt approach as needed. Make A Difference Blue Cross 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 [email protected]. 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. Blue Cross and 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, or any other legally protected characteristic.