Job Description

Your Role

The Blue Shield of California (BSC) Network and Provider Partnership team is responsible for the BSC Provider Contracting and Provider Relations activities for BSC. The Director, Provider Contracting will report to the Vice President of Network and Provider Partnerships Southern California. In this role, you will be responsible for participating in and leading the network team's development of the multi-year contracting strategy for assigned providers and ongoing provider network maintenance. This will include unit cost trend targets and specific metrics to improve our overall competitive position. Additionally, you will lead cross functional work to drive process improvement opportunities for improved provider experience. You will also participate in committees and initiatives to help manage the total cost of health care for the lines of business for their assigned territory that typically results in savings of $1M+ plus in annual cost.

Responsibilities

Your Work

In this role, you will:

• Be responsible to drive and manage the provider network, network performance, and strategy for assigned providers
• Work closely with the Network Leadership team to direct the line of business network strategy including defining business requirements and resources to implement network strategic contract initiatives for assigned providers
• Grow BSC membership based upon work with providers delivering a network that is best in class in meeting BSC's mission
• Coordinate contractual required communications for network providers consistent with all regulatory requirements and strategic initiatives
• Educate network managers and provider relations on BSC network strategy and regulatory requirements
• Influence BSC's Network strategy and providing perspective based upon interactions with providers to leadership, along with driving necessary pivots to the strategy as needs arise due to changes in the environment
• Monitor performance of assigned network providers to ensure metrics are met for provider performance, compliance, quality, and financial measures
• Develop overall contracting strategy for assigned provider relationships in consultation with Network Analytics (and other key stakeholders) to ensure adequate provider networks and contracts that meet all regulatory requirements with respect to Access & Availability and DMHC requirements
• Lead the contracting and provider relations team to ensure best practices in negotiations and provider relations are in place
• Drive network compliance for assigned provider network, based upon internal review and oversight, incorporating issues and concerns identified by internal and external partners for delegated IPA/MG and Capitated Hospitals

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 10 years of provider contracting experience at a senior negotiator level, including at least 6 years of people management experience at a health plan or in a provider organization
• Knowledge of health plan operations, products, and competitor marketplace
• Experience and working knowledge of the California provider marketplace
• Excellent interpersonal and communication skills, including effective delivery of executive level reports and in-person presentations
• Proficiency working with MS Office products (including Teams)]
• Ability and willingness to explore newer Artificial Intelligence (AI) tools

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.