Manager, Provider Services - Network bei Blue Shield of California Group
Blue Shield of California Group · Long Beach, Vereinigte Staaten Von Amerika · Hybrid
- Senior
- Optionales Büro in Long Beach
Your Role
The Network Performance Analysis and Contracts (NPAC) team is part of the Network Management and Provider Partnerships department and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield of California (BSC) and Promise Health Plan's (PHP) network of physicians, hospitals, ambulatory surgery centers, HMO IPAs, and medical groups. As the Manager, Provider Services – Network, you will lead a dedicated team to ensure the accurate and timely completion of all provider network regulatory filings for CMS, DMHC, DHCS, and CDI. Reporting to the Director, Provider Services – Network, your role will involve supporting ad hoc strategic evaluations, reporting, and filings as needed. Additionally, you will play a critical role in driving alignment and providing recommendations to leadership regarding the team's work, contributing to the overall success and compliance of the organization.
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.
Responsibilities
Your Work
In this role, you will:
- Lead the team to achieve the required tasks, ensuring all outputs meet the high expectations of both internal and external clients
- Support the success of the company's key strategic initiatives by ensuring the approval and expansion of provider networks with regulatory agencies (DMHC, CDI, DHCS, CMS). This is critical for the company's strategy to sell and grow in specific markets and products
- Fulfill regulatory requirements and filings, including Access and Availability, DMHC (TAR, 10% change), DHCS required filings, and Covered CA, to ensure continued marketing and sales of existing provider networks
- Assist the Director and collaborate with business partners to create a strategic vision involving analytical tools, process improvements, and product/service offerings
- Work with the team to execute the strategic vision through milestones, deliverables, and performance measurement. Identify and manage risks associated with the strategic vision
- Develop and implement short-term and long-term strategies to improve team results and meet company goals
- Lead the team to ensure all provider network regulatory filings for CMS, DMHC, DHCS, and CDI are completed accurately and on time
- Support ad hoc strategic evaluations, reporting, and filings as needed
- Collaborate with key stakeholders to manage end-to-end processes impacting provider network regulatory filings and reporting, ensuring high-quality output
- Develop and present metrics and dashboards during committee meetings
- Assist the team in identifying and implementing process improvements to support ongoing changes in the regulatory environment and requirements
Qualifications
Your Knowledge and Experience
Requires a college degree or equivalent experience
Requires 7 years of prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager
Project management experience
Strong knowledge of provider networks and healthcare system
Strong interpersonal skills, ability to work effectively and build relationships with subordinates, peers, senior-level staff, cross-functional teams
Ability to lead and influence cross-functional teams, including teams with senior-level leadership involvement or oversight
Strong analytical, problem-solving, and critical thinking skills
Ability to navigate ambiguous problems and breakdown complex issues into manageable chunks for structured problem-solving
Ability to influence and drive decision making among all levels of stakeholders
About Company
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
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 listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
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.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
