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Senior Manager, Provider Contracting

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: September 18, 2022

Job Description:

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. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The Provider Partnerships & Network Management team is responsible for managing California's largest PPO Physician Network to support our members in achieving access to high quality care at an affordable price. The Sr. Manager, Provider Contracting will report to the Director, PPO Professional, Specialty & Ancillary Networks. In this role you will lead a high performing team to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. 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.

Your Work

In this role, you will:

  • Help develop unit cost trend targets and specific metric improvement for all providers within the assigned region to constantly improve overall competitive position
  • Participate in or lead cross functional teams to implement initiatives to help manage the total cost of health care across the assigned region and manage larger strategic initiatives across regions or statewide
  • Work closely with the contracting team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets
  • 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
  • Improve and maintain highly competitive unit costs across all products to 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
  • Helps implement department goals under the leadership of the Contracting Executives and ensures alignment of these goals with the 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
  • Track and trend data and identify potential contracting or service-improvement opportunities
  • Responsible for adjusting or recommending system enhancements and process improvements to solve problems or improve effectiveness of job area

    Qualifications:

    Your Knowledge and Experience

    • Requires a bachelor's degree or equivalent experience
    • Requires at least 10 years of provider contracting experience at a senior negotiator level, including at least 4 years of people management experience at a health plan or in a provider organization
    • Broad health care strategy and overall industry knowledge
    • 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 experience/exposure
    • Excellent oral and written communication skills
    • Ability to support change efforts with cross-functional teams and external partners

      Our Values

      • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short
      • Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
      • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals

Keywords: Blue Shield of California, Rancho Cordova , Senior Manager, Provider Contracting, Executive , Rancho Cordova, California

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