Director, Provider Contracting - Northern or Southern Califo
Company: Blue Shield of California
Location: El Dorado Hills
Posted on: April 8, 2021
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.
- 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
- 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
- Identify and develop best in class talent.
- Travel up to 20% of the time if living in local market
- 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
- Minimum of 6 years of people management experience at a health
plan or provider organization.
- Understanding of the California healthcare market
- Management experience in leading high performing teams.
- Broad and deep health care strategy and overall industry
knowledge, and understanding of the California health care
- 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
- Excellent negotiation and conflict-resolution skills.
- Superior interpersonal skills with the ability to build
positive relationships with key internal and external
- 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
- Excellent strategic thinking, analytical, and problem-solving
- 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
- 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
- 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
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