Job DescriptionYour RoleThe Network Strategy team is a team of strategists and program managers that are responsible for developing and executing a Blue Shield of California (BSC) Provider Partnerships & Network Management strategy.
The Sr. Director, Strategic Planning and Performance (Network Strategy) will report to the VP, Network Strategy. In this role, you will be responsible for driving and executing a multi-year strategic roadmap for network design and optimization and provider partnerships; partnering closely with line of business (LOB) leaders to establish and execute statewide, regional and LOB-level Network strategic roadmaps. You will function as the Business Owner for strategic and operational initiatives designed to execute on the strategic roadmaps. Additionally, you will be responsible for identifying and executing on opportunities to drive affordability and will serve as the Provider Partnerships & Network Management leadership representative to the Affordability Office.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
ResponsibilitiesYour Work In this role, you will:
- Partner with the VP, Network Strategy to drive and execute on robust strategic roadmaps for each LOB and region, aligning network design, affordability goals, market needs, and product strategies into a cohesive, actionable plan
- Identify and execute on Cost of Health Care (COHC) affordability opportunities
- Lead team on complex initiatives to deliver on COHC savings targets and drive operational excellence
- Lead Network initiatives under the Affordability Office and serve as primary liaison to Affordability Office
- Create scalable, structured provider engagement and backend operating model that drives provider performance and addresses key pain points: Provider Accounts Receivable, Recoupments & Claims Issue Resolution
- Collaborate extensively with cross-functional partners to drive a cross-functional process to build and deploy an operating model with touchpoints across Provider Partnerships, Contracting, Provider Relations, Quality, Claims, Delegation Oversight, Network Operations, Provider Operations, and Regional Medical Directors
- Own the implementation, and optimization of a provider CRM platform delivering a unified, enterprise-wide, 360° view of BSC interactions with providers
- Lead the provider analytics strategy supporting network design, performance management, provider selection, and evaluation of strategic partnerships
- Develop, implement, and manage the Network Governance framework that drives enterprise-wide decision-making, transparency, and prioritization for Network Strategy and critical network decisions
- Drive analytics and process automation to enable scaling from Tier 1 to Tier 2 providers
- Lead the technology enablement roadmap for Network Strategy
- Partner closely with Provider Operations, Provider Transformation, and IT/Stellarus to develop and execute multi-year roadmap that supports stable and efficient operations and delivers key high-value enhancements
QualificationsYour Knowledge and Experience- Requires a Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree. A Master's degree (MBA or MPH) is preferred
- Requires 12 years of prior relevant experience with at least 10 years of Provider or Health Plan experience and experience leading complex, strategic portfolio of business and IT initiatives. Fifteen (15) years of experience is preferred
- Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
- Deep knowledge of Network Strategy, Contracting, Operations, and Compliance
- Proven ability to build and lead high-performing teams
- Certifications preferred: Project Management Professional (PMP), Lean Six Sigma, Agile
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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