Sr. Manager, Provider Contracting 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 Management team consists of Contract Negotiators and Provider Relations in the Central Valley. The Sr Manager, Provider Contracting will report to the Director, Provider Contracting. In this role you will lead contracting specialists managing provider issues, contract process, contracting questions, and project assignments. 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:
Primarily manage contract negotiations with Hospital and Provider Group capitation in the Central Valley
Drive unit cost trend targets and specific metric improvements within contract negotiations
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 internal departments to ensure best practices operationally through 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
Participate and collaborate in discussions around development and/or implementation of provider networks
Collaborate with internal departments on best practices for aligned communications to providers; which may include improved processes and tools
Qualifications
Your Knowledge and Experience
Requires a college degree or equivalent experience
Requires 10 years 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
Requires substantial experience in managing complex and high-profile provider negotiations
Requires practical knowledge in leading and managing the execution of processes, projects and tactics within an area
Advanced knowledge and skills including technical or functional expertise, business acumen, financial analyses skills, risk management, delegation skills, critical thinking and decision making skills
In-depth knowledge of Blue Shield of California’s mission, vision and strategy and healthcare industry environment
Comprehensive understanding of contracting practices for hospital and cap arrangements with both provider groups and hospitals
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.
