Director, Provider Contracting - Northern or Southern Califo

Company: Blue Shield of California
Location: El Dorado Hills
Posted on: April 8, 2021

Job Description:

Director, Provider Contracting - Northern or Southern California This position will require 20% day travel once we are released to travel from the COVID 19 Pandemic but is a remote role working from home until then. Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone. The Director of Provider Contracting leads a high performing team responsible for managing Provider Contracting for hospitals, medical group/IPAs, ambulatory surgery centers and skilled nursing facilities for some portions of Northern California to support up to $2 billion in annual spend. Additional responsibilities will include leading and participating in strategic initiatives to support BSC's critical few, including but not limited to network expansion, ACO performance, cost of health care savings opportunities, collaboration with Medical Care Solutions, Medicare team and other functional areas as necessary and support markets team with client presentations. The successful candidate will have a broad understanding of managed care, a successful track record of large scale provider negotiations, strong leadership skills, and the solid analytical mindset needed to make data driven decisions. The qualified candidate must be willing to travel within California as necessary. Responsibilities

• Develop unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve overall competitive position and oversee an annual spend of approx. $500M - $3B.
• Initiatives representing an additional $2M - $50M in annual cost.
• Work closely with other contracting teams to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets, as well as contractual compliance with government relations.
• Establish department goals under the leadership of the Network Management and Provider Partnerships executives to ensure alignment of these goals with company's broader strategic priorities.
• Continually review and modify contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities, and oversee an operating budget of approximately $1.2M.
• Support the Markets organization in the support and acquisition of key employer accounts.
• Improve and maintain highly competitive unit costs across all products and in doing so will ensure that a superior provider network is available to all employer groups.
• Provide strong and focused leadership to the negotiating team directly accountable for achieving department metrics.
• Set up Blue Shield and Growth and Health Solutions for long term success through critical organizational initiatives.
• Role model collaborative, trusting peer relationships; drive through organization to reduce silos with key business partners.
• Identify and develop best in class talent.
• Travel up to 20% of the time if living in local market otherwise 50%.
• Work with the team to hone leadership skills as well as negotiating skills and technical expertise and help the team develop their ability to optimally utilize internal and external analytical (and other) tools to effectively manage negotiations. Knowledge, Experience and Education
  • A minimum of a Bachelor's degree in business, health care policy, public health or related field.
  • Advanced degree preferred.
  • Minimum of 10 years provider contracting/negotiation experience at a senior negotiator level, including experience managing complex system negotiations.
  • Minimum of 6 years of people management experience at a health plan or provider organization.
  • Understanding of the California healthcare market preferred.
  • Management experience in leading high performing teams.
  • Broad and deep health care strategy and overall industry knowledge, and understanding of the California health care landscape.
  • In-depth understanding of provider reimbursement methodologies and provider contract language.
  • Demonstrated leadership, change management, collaboration, coaching and mentoring skills.
  • Demonstrated ability to develop and lead high performing teams.
  • Excellent negotiation and conflict-resolution skills.
  • Superior interpersonal skills with the ability to build positive relationships with key internal and external partners.
  • Excellent verbal, written, and presentation skills with the ability to convey complex information in a manner that others can understand at all levels of the organization.
  • Strong influence skills.
  • Superior technical skills in provider contracting strategy, reimbursement methodologies and provider network analysis.
  • Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure.
  • Excellent strategic thinking, analytical, and problem-solving skills.
  • Possess a performance and results driven management style.
  • Ability to work cross-functionally and collaboratively across internal and external teams.
  • Effective in planning, organizing, and balancing multiple projects and priorities with successful outcomes. Additional Information
    • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
    • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
    • Requisition ID: 210014K
    • Posting Date: Mar 16, 2021
    • Schedule: Full-time My Profile Create and manage profiles for future opportunities. If you have a disability and need assistance applying for a position with Blue Shield of California, call RehabWest, Inc. at (760)759-7500.

Keywords: Blue Shield of California, Sacramento , Director, Provider Contracting - Northern or Southern Califo, Executive , El Dorado Hills, California