Blue Cross & Blue Shield of Kansas, Inc.
AVP Chief of Clinical Operations, Quality, & Strategy
Blue Cross & Blue Shield of Kansas, Inc., Des Moines, Iowa, United States
AVP Chief of Clinical Operations, Quality, & Strategy page is loaded## AVP Chief of Clinical Operations, Quality, & Strategylocations:
Kansas:
Missouritime type:
Full timeposted on:
Posted 2 Days Agotime left to apply:
End Date: January 12, 2026 (11 days left to apply)job requisition id:
R2025767Blue Cross and Blue Shield of Kansas is looking to add to our Medical Affairs teams and has a new opportunity for an AVP Chief of Clinical Operations, Quality & Strategy. This position provides strategic leadership and oversight for Utilization Management and other key clinical initiatives. This position leverages evidence-based methodologies and enterprise data assets to drive continuous quality improvement and advance population health outcomes. A catalyst for enterprise-wide transformation, this leader champions strategic initiatives that enhance clinical programs through collaboration and cross-functional partnership. This position reports to Senior Vice President, Chief Medical Officer.
“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”* **Make a Positive Impact:** Your work will directly contribute to the health and well-being of Kansans.* **Lead and Inspire:** Guide and mentor your team to achieve their full potential and success.* **Family** **Comes First**: Total rewards package that promotes the idea of family first for all employees.* **Dynamic Work Environment:** Collaborate with a team of passionate and driven individuals.* **Trust:** Work for one of the most trusted companies in Kansas**What you’ll do*** Provide clinical leadership to transform Utilization Management by promoting cost-effective, evidence-based healthcare delivery.* Lead, mentor, and develop a high-performing clinical team, fostering collaboration, accountability, and professional growth. Build succession plans and talent strategies to support long-term organizational success.* Ensure strategic alignment of clinical programs, benefit design, and internal resources to optimize member outcomes and alignment of goals across the enterprise.* Provide fiscal oversight for clinical programs, including budget development, monitoring, and alignment with enterprise affordability goals. Ensure financial stewardship and accountability for cost containment and ROI on strategic initiatives.* Lead high-impact clinical projects that support affordability and corporate strategic projects and programs to deliver results on all strategic initiatives.* Develop and integrate innovative clinical programs, promoting whole-person care and dismantling silos.* To oversee clinical operations including prior authorization, medical necessity reviews, and post-service payment integrity/claims review to develop operational excellence.* Use evidence-based practices and analytics to drive continuous performance improvement.* Identify and mitigate operational and strategic risks within clinical programs. Champion change management initiatives to ensure successful adoption of new processes, technologies, and cultural shifts across the enterprise.* Maintain compliance with state/federal regulations and accreditation standards.* Represent the organization as a clinical strategy thought leader at industry conferences, regulatory meetings, and client engagements. Serve as a trusted advisor to external stakeholders and promote the organization’s vision for clinical transformation.**What you need*** Medical Degree (MD or DO) or equivalent clinical doctorate required; Bachelor’s degree in medicine, nursing, or a related clinical field also required.* Minimum of 10 years of progressive, relevant clinical experience in care delivery, managed care, or population health, with a strong working knowledge of healthcare operations – required.* Minimum 5 years of experience in a senior leadership role, preferably within the health insurance industry – required.* Minimum of 3 years of experience in utilization management leadership or a closely related area – required.* Demonstrated success in leading enterprise-wide clinical initiatives and operational transformation.**Knowledge/Skills/Abilities:*** Deep understanding of Population Health and Managed Care operations.* Strong analytical skills, including ROI analysis and performance improvement.* Expertise in regulatory compliance and accreditation.* Experience in clinical innovation and change management.* Excellent communication and stakeholder engagement skills.* Strong Data Analytics and Health Analytics skills and oversight.* Experience in leading with a data-driven approach, key performance indicators and well versed with performance management expertise.* Ability to champion the design and deployment of innovative program initiatives, translating strategic objectives into actionable workflows tailored to new digital platforms.* Directed cross-functional teams in the rollout of new technology platforms, creating scalable processes and training protocols to support adoption and long-term success.* Proven ability to lead organizational change and manage risk in complex healthcare environments.* Experience presenting to executive leadership and external stakeholders, including regulatory bodies and industry forums.**Bonus if you have*** Advanced degree preferred (e.g., MPH, MBA).* Professional certification in Healthcare Quality, Executive Leadership, or Project Management preferred.**Benefits & Perks*** Base compensation is only one component of your competitive Total Rewards package
+ Incentive pay program (EPIP)
+ Health/Vision/Dental insurance
+ 6 weeks paid parental leave for new mothers and fathers
+ Fertility/Adoption assistance
+ 2 weeks paid caregiver leave
+ 5% 401(k) plan matching
+ Tuition reimbursement
+ Health & fitness benefits, discounts and resources**Our Commitment to Connection and Belonging**At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs.
Our mission: Being the insurer Kansans trust with their health.**Our Commitment to Connection and Belonging**At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic #J-18808-Ljbffr
Kansas:
Missouritime type:
Full timeposted on:
Posted 2 Days Agotime left to apply:
End Date: January 12, 2026 (11 days left to apply)job requisition id:
R2025767Blue Cross and Blue Shield of Kansas is looking to add to our Medical Affairs teams and has a new opportunity for an AVP Chief of Clinical Operations, Quality & Strategy. This position provides strategic leadership and oversight for Utilization Management and other key clinical initiatives. This position leverages evidence-based methodologies and enterprise data assets to drive continuous quality improvement and advance population health outcomes. A catalyst for enterprise-wide transformation, this leader champions strategic initiatives that enhance clinical programs through collaboration and cross-functional partnership. This position reports to Senior Vice President, Chief Medical Officer.
“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”* **Make a Positive Impact:** Your work will directly contribute to the health and well-being of Kansans.* **Lead and Inspire:** Guide and mentor your team to achieve their full potential and success.* **Family** **Comes First**: Total rewards package that promotes the idea of family first for all employees.* **Dynamic Work Environment:** Collaborate with a team of passionate and driven individuals.* **Trust:** Work for one of the most trusted companies in Kansas**What you’ll do*** Provide clinical leadership to transform Utilization Management by promoting cost-effective, evidence-based healthcare delivery.* Lead, mentor, and develop a high-performing clinical team, fostering collaboration, accountability, and professional growth. Build succession plans and talent strategies to support long-term organizational success.* Ensure strategic alignment of clinical programs, benefit design, and internal resources to optimize member outcomes and alignment of goals across the enterprise.* Provide fiscal oversight for clinical programs, including budget development, monitoring, and alignment with enterprise affordability goals. Ensure financial stewardship and accountability for cost containment and ROI on strategic initiatives.* Lead high-impact clinical projects that support affordability and corporate strategic projects and programs to deliver results on all strategic initiatives.* Develop and integrate innovative clinical programs, promoting whole-person care and dismantling silos.* To oversee clinical operations including prior authorization, medical necessity reviews, and post-service payment integrity/claims review to develop operational excellence.* Use evidence-based practices and analytics to drive continuous performance improvement.* Identify and mitigate operational and strategic risks within clinical programs. Champion change management initiatives to ensure successful adoption of new processes, technologies, and cultural shifts across the enterprise.* Maintain compliance with state/federal regulations and accreditation standards.* Represent the organization as a clinical strategy thought leader at industry conferences, regulatory meetings, and client engagements. Serve as a trusted advisor to external stakeholders and promote the organization’s vision for clinical transformation.**What you need*** Medical Degree (MD or DO) or equivalent clinical doctorate required; Bachelor’s degree in medicine, nursing, or a related clinical field also required.* Minimum of 10 years of progressive, relevant clinical experience in care delivery, managed care, or population health, with a strong working knowledge of healthcare operations – required.* Minimum 5 years of experience in a senior leadership role, preferably within the health insurance industry – required.* Minimum of 3 years of experience in utilization management leadership or a closely related area – required.* Demonstrated success in leading enterprise-wide clinical initiatives and operational transformation.**Knowledge/Skills/Abilities:*** Deep understanding of Population Health and Managed Care operations.* Strong analytical skills, including ROI analysis and performance improvement.* Expertise in regulatory compliance and accreditation.* Experience in clinical innovation and change management.* Excellent communication and stakeholder engagement skills.* Strong Data Analytics and Health Analytics skills and oversight.* Experience in leading with a data-driven approach, key performance indicators and well versed with performance management expertise.* Ability to champion the design and deployment of innovative program initiatives, translating strategic objectives into actionable workflows tailored to new digital platforms.* Directed cross-functional teams in the rollout of new technology platforms, creating scalable processes and training protocols to support adoption and long-term success.* Proven ability to lead organizational change and manage risk in complex healthcare environments.* Experience presenting to executive leadership and external stakeholders, including regulatory bodies and industry forums.**Bonus if you have*** Advanced degree preferred (e.g., MPH, MBA).* Professional certification in Healthcare Quality, Executive Leadership, or Project Management preferred.**Benefits & Perks*** Base compensation is only one component of your competitive Total Rewards package
+ Incentive pay program (EPIP)
+ Health/Vision/Dental insurance
+ 6 weeks paid parental leave for new mothers and fathers
+ Fertility/Adoption assistance
+ 2 weeks paid caregiver leave
+ 5% 401(k) plan matching
+ Tuition reimbursement
+ Health & fitness benefits, discounts and resources**Our Commitment to Connection and Belonging**At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs.
Our mission: Being the insurer Kansans trust with their health.**Our Commitment to Connection and Belonging**At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic #J-18808-Ljbffr