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 programsincluding 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

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

Job Qualifications

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.

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