Job Description

Your Role

The Network Operations team sets the strategic direction for operational processes, network compliance, contract operations, and provider relations for Blue Shield and Blue Shield Promise Health Plan. This work ensures provider contract alignment, supports financial stewardship, strengthens enterprise governance, and advances strategic priorities across multiple lines of business. Reporting to the Vice President, Network Operations, the Director, Network Operations plays a leadership role, guiding data-driven contracting approaches to improve provider network effectiveness while aligning and executing operational initiatives and governance to serve Blue Shield of California and Blue Shield of California Promise Health Plan's (collectively "Blue Shield") best interests. This position works closely with the Vice President of Network Operations to establish priorities while designing a comprehensive execution plan that effectively integrates each of the areas within the department. The Senior Principal will collaborate with multiple areas within the organization to design and implement roadmaps leading to efficient cost of healthcare strategies.

We are actively recruiting candidates within 50 miles of our BSC offices in Woodland Hills, Long Beach, and San Diego ONLY.

Responsibilities

Your Work

In this role, you will:

• Lead cross-functional initiatives and teams involving finance, actuarial, clinical, and operations teams to ensure policies and procedures are aligned with optimal contract terms
• Develop and design the implementation of the overall Network Operations departmental goals and execution plans aligned with organizational strategy
• Partner closely with the Network Strategy team to design Network Strategic & Operational roadmaps to support enterprise affordability & growth goals
• Identify provider contract exposure points, inclusive of language and rate structures, and then design and implement operational and contractual mitigation strategies
• Apply advanced modeling and analytical frameworks to assess contract performance and efficient management of total cost of healthcare
• Provide leadership to drive data-driven strategies to optimize provider network performance and align with organizational goals
• Proactively assess and address risks impacting network resiliency, provider accessibility, and member experience, reinforcing long-term stability and operational efficiency
• Lead the documentation and maintenance of policies, procedures, and governance structures to support high-quality, timely and compliant deliverables
• Partner with internal stakeholders to strategize and prioritize system and procedural enhancements
• Communicate updates, risks, and strategic recommendations to leadership and governance committees
• Actively participate in collaborative, trusting peer relationships helping to drive the organization to reduce silos with key business partners.
• Integrate and optimize business processes across Provider Partnerships and Network Management in support of the Blue Shield strategic and operational needs
• Role model collaborative, trusting peer relationships; drive through organization to reduce silos with key business partners.

Qualifications

Your Knowledge and Experience

• Requires a Bachelor's degree required; advanced degree preferred (MBA, MPH, MHA)
• Requires a minimum of 10 years' experience in health plan operations, including data analytics and project management
• Requires 6 years of management experience
• Lean Six Sigma process improvement certification (Black Belt preferred) or Project Management Professional (PMP) certification strongly preferred or equivalent training and experience
• Proven ability to structure execution across complex programs and initiatives with cross-functional teams
• Requires knowledge in provider contracting, regulatory compliance, and end-to-end health plan operations
• Requires excellent analytical, organizational, and problem-solving skills
• Requires excellent written and verbal communication skills with a proven track record in effective relationship building and influencing stakeholders at all levels of the organization

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.