Director Clinical Strategy

Blue Cross and Blue Shield of Kansas•Topeka, KS

3d•Hybrid

About The Position

The Director of Clinical Strategy, reporting to the AVP, Clinical Operations, Quality and Strategy, serves as a clinical and strategic leader responsible for aligning Medical Affairs strategy with enterprise priorities, regulatory requirements, and evolving payer trends. This role establishes and executes the divisional strategic roadmap, integrates clinical, operational, data, and technology initiatives, and ensures strategic initiatives are consistently operationalized through structured governance and cross functional integration across Medical Affairs and the broader enterprise. The Director works closely with clinical leadership, enterprise partners, and external vendors to drive modernization, affordability, and whole person care outcomes. This position also partners closely with IT&S, Analytics, Operations, and Population Health to ensure strategy, systems, and data structures are aligned to payer modernization and enterprise transformation goals. “This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.” Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First: Total rewards package that promotes the idea of family first for all employees. Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Trust: Work for one of the most trusted companies in Kansas Stability: 80 years of commitment, compassion and community

Requirements

Strategic vision with the ability to translate enterprise priorities into executable clinical and operational plans.
Deep knowledge of clinical operations, medical policy, utilization management, quality programs, and regulatory frameworks.
Demonstrated success integrating processes, systems, data, and teams across complex payer environments.
Strong analytical skills with the ability to synthesize data into actionable insights and performance measures.
Effective communication and influence skills with clinicians, executives, regulators, and vendors.
Proven ability to manage complex, multi‑stakeholder initiatives and vendor relationships.
Change leadership capability, including navigating resistance and building alignment during transformation.
Ability to lead through matrixed influence and provide coaching to supporting roles (e.g., Operational Specialist, Program Manager)
Bachelor’s degree required in healthcare administration, nursing, business, public health, or a related field.
Clinical background required (RN, MD/DO, APRN, PA, or equivalent).
Minimum of 8 years of overall professional experience in healthcare, preferably within a payer, integrated delivery system, or large healthcare organization.
Minimum of 5 years of progressive leadership experience (clinical, operational, or strategic) with demonstrated responsibility for cross-functional initiatives or programs.

Nice To Haves

Experience with clinical integration, utilization management modernization, regulatory compliance, accreditation (URAC/NCQA), and quality program execution is strongly preferred.
Preference for clinicians licensed in the State of Kansas or eligible for licensure.

Responsibilities

Establish and lead the Medical Affairs strategic roadmap aligned with enterprise strategy, affordability goals, regulatory requirements, and population health priorities.
Serve as a strategic liaison between Medical Affairs and enterprise business partners to coordinate and align cross‑functional initiatives.
Lead integration of clinical processes, systems, data, and strategic frameworks across utilization management, quality, care management, clinical programs, and medical policy.
Partner with technology and analytics teams to modernize clinical platforms, enable interoperability, and strengthen data‑driven decision making.
Ensure alignment with medical policy, accreditation standards, regulatory requirements, and affordability initiatives.
Provide clinical oversight and performance management of external vendors, including evaluation against contractual expectations, accreditation requirements, KPIs, and workflow integration.
Support development of unified data structures and reporting standards across Medical Affairs to enable consistent, accurate insight generation.
Develop and lead performance dashboards, scorecards, and insight reports to monitor strategic progress and clinical and operational outcomes.
Lead Medical Affairs contributions to enterprise transformation initiatives, including UM modernization, whole‑person care, digital transformation, and cross-functional execution through operational and program support partners.