Job DescriptionYour Role The Provider Network Management team is responsible for provider contracting and network performance across California. The Provider Contracting Specialist, Consultant is accountable for executing an assigned portfolio of provider negotiations and contracting initiatives within the statewide strategies, governance standards, priorities, and escalation framework established by contracting leadership.
In this role, you will independently manage complex provider negotiations and contracting initiatives from strategic and financial analysis through execution, implementation, and issue resolution. You will partner across the organization to advance affordability, network access, and business objectives while ensuring work is executed within established contracting strategies, policies, controls, and approval requirements. You will be accountable for the timely execution and performance of your assigned portfolio, proactively identifying risks and escalating matters requiring broader policy, resource, or executive decisions.
ResponsibilitiesYour Work In this role, you will:
- Lead assigned provider negotiations and renewals through contract execution and implementation, within established strategy, financial parameters, and approval requirements.
- Develop negotiation strategies, financial analyses, business cases, term sheets, and contract recommendations for assigned providers, with appropriate leadership review and approval.
- Manage assigned contracting activities, milestones, risks, dependencies, and implementation requirements to support timely and accurate execution
- Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, Legal, Operations, and Sales to support affordability, network, and business objectives
- Identify network, reimbursement, utilization, and unit-cost opportunities within assigned providers and recommend practical actions to contracting leadership
- Investigate and resolve provider, contract, and implementation issues within delegated authority, identifying root causes and escalating material risks, policy questions, or barriers as appropriate
- Apply established contracting policies, procedures, templates, controls, and approval requirements consistently across assigned work
- Act with urgency, sound judgment, and accountability to meet negotiation, approval, contract execution, and implementation commitments
QualificationsYour Knowledge and Experience - Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree required
- 7 years of prior relevant experience required
Previous experience with provider contracting and negotiation experience, including experience managing complex negotiations and provider contracting processes preferred - Advanced working knowledge of provider contracting, reimbursement methodologies, provider contract language, financial impact analysis, and provider network management preferred
- Working knowledge of managed care operations and the financial, operational, legal, regulatory, and member implications of provider agreements preferred
- Demonstrated ability to interpret data, evaluate alternatives, develop negotiation strategies, and translate analysis into practical recommendations preferred
- Strong project and portfolio-management skills, including the ability to manage multiple negotiations, milestones, dependencies, and competing priorities preferred
HybridThis 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.
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