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VP of Clinical Excellence and Quality

Employer
Blue Cross Blue Shield of ND
Location
Fargo, ND
Salary
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Job Details

The VP of Clinical Excellence and Quality is responsible to provide leadership, direction and motivation to the medical review, care management and quality management teams within the division. This role is accountable for the efficient operations and work processes of medical policy development and implementation, member care management, provider relationships as related to the improvement of member experience and quality outcomes, and the planning and implementation of clinical functions and resources to meet corporate business goals.

Essential Functions

  • Directs, leads and oversees staff in accomplishing work objectives within the unit(s). Coaches, motivates, rewards and recognizes subordinates. Sets clear goals, objectives and performance expectations and holds employees accountable for achieving results.
  • Provides leadership through the recruitment, hiring, training, engagement, performance management and supervision of its employees to attain the necessary clinical and quality goals of the Company.
  • Delivers collaborative strategic leadership within the division in setting long and short term goals to advance value-based programs and medical policies for members.
  • Oversees development, implementation and leadership for areas of responsibility to ensure the organization supports members and providers in appropriately managing medical necessity for member health care services and the ability of providers to deliver these medical services.
  • Ensures the division is meeting accreditation standards and achieving desired performance levels with respect to claims processing for medical review, medical policy development and implementation, care management and deriving the appropriate cost of care for members.
  • Fosters effective leadership to achieve the best customer experience possible for members, providers, staff, employer groups, the Association, and other constituents, as well as promoting and furthering corporate goals relative to areas of responsibility. This includes partnering with and educating regulators, politicians, board members, policy-makers, associations, state officials, community leaders, providers and various influential representatives of the healthcare community on the merits and effects of healthcare policy and practice.
  • Drives innovative solutions for the clinical and quality activities and systems for effectiveness, efficiency and consistency with enterprise-wide strategic objectives.

Requirements

Knowledge, Skills and Abilities

Staff Leadership

Advanced

Technical/Professional Knowledge and Skills

Advanced

Relationship Management

Advanced

Strategic Focus

Advanced

Presentation Skills

Advanced

Business Acumen

Advanced

Education Requirements

Required: Bachelor's

Preferred: Master's

Field(s) of Study: Nursing (BSN)

Experience Requirements

Required: Minimum of 10 Years

Preferred: Minimum of 10 Years

Experience Details: Minimum of 10 years of clinical, healthcare, insurance industry or related experience is required, of which 7 years of supervisory/staff leadership experience is required; demonstrated clinical and nursing leadership experience is required.

Certification, Licensures & Registration Requirements

Title: North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND

State or Agency: Board of Nursing

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Other Information

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 10/26/2018 at 8:00AM CST. No further applications will be considered.

Company

TWO WORDS – MEMBERS FIRST.

That sums up why we’re here. And according to member satisfaction surveys, 95.6% say we’ve done a great job at maintaining that focus.

With that said, there are still mountains to move. America’s health care system needs an overhaul and Blue Cross Blue Shield of North Dakota is taking a lead role. To accomplish that, we need BOLD people who believe they can make an impact.

Are you ready to shake up an industry?

If you’re passionate about taking on our nation’s number one health care concern, there may be a place for you on one of our teams.

Company info
Website
Location
4510 13th Ave. S.
Fargo
ND
58103
United States

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