Senior Manager, Network Operations presso Blue Shield of California Group
Blue Shield of California Group · Woodland Hills, Stati Uniti d'America · Onsite
- Senior
- Ufficio in Woodland Hills
Your Role
The Network Operations team is responsible for working with cross-functional teams to shape and execute the strategic vision for Network Management ensuring financial stewardship, driving transformative initiatives to optimize network performance, enhance provider and member experience and strengthen governance across multiple lines of business. The Senior Manager, Network Operations will report to the VP, Network Operations. In this role you will lead the Network Transitions team to establish processes and procedures to coordinate with interdepartmental teams to manage and monitor the operational efforts associated with provider terminations. This responsibility involves communicating with executive and line of business leadership, ensuring internal teams are informed and resourced to provide optimal member experience. This role will also work with the VP, Network Operations to manage various projects aligned with the department’s strategic and operational objectives.
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 Network Transition team in overseeing the monitoring of provider renewals and potential termination process for all lines of business, including risk-bearing medical groups/IPAs, hospitals, integrated health systems, and PPO individual providers
Collaborate cross-departmentally to develop and maintain documented policies and procedures related to provider renewals and terminations
Drive ongoing process improvement by performing gap analyses, evaluating lessons learned, and integrating stakeholder feedback
Develop and manage consistent inter-departmental and multi-level communication channels to support organizational alignment and engagement
Conduct and organize internal operations meetings with stakeholders and leadership to support coordination, accountability and timely completion of work associated with renewals and terminations
Analyze complex data sets to deliver actionable insights that support strategic decision-making within Network Operations
Evaluate the operational effects of negotiations and formulate suitable mitigation strategies
Coordinate with the Network Management Contracting team to execute and communicate internal operational strategies related to contract renewals
Identify and prioritize project risks, escalating significant issues to leadership with recommended actions and appropriate urgency to enable timely decisions
Oversee the expanded scope of the Network Transition Team as evolving requirements affect multiple types of providers and lines of business
Work collaboratively with internal stakeholders to ensure teams are equipped with necessary resources to maintain regulatory compliance, enhance member experience, and uphold network integrity
Support the establishment of governance frameworks to strengthen accountability, transparency, and effective decision-making throughout network operations
Sets operational objectives for the Network Transition team and collaborates with other managers to define group objectives
Contribute to the design and execution of strategic initiatives that enhance the provider network’s influence on member experience, while ensuring alignment with overarching healthcare quality and affordability objectives
Promote a collaborative and partnership-oriented culture by nurturing strong relationships with internal stakeholders to achieve collective success
Qualifications
Your Knowledge and Experience
Bachelor’s degree in business administration, Healthcare Administration, or a related field is required
Minimum of ten years of relevant experience in health plan strategy, managed care operations, or provider contracting, including at least four years in management or matrixed management roles
Previous experience in extensive healthcare program or project management
Outstanding verbal and written communication abilities, with demonstrated effectiveness when engaging executive leadership
Comprehensive knowledge of managed care risk contracts and the operational requirements involved in managing a provider network
Proven capability to manage a portfolio; prioritizing multiple tasks and objectives simultaneously
Skilled in handling highly confidential information and serving as a liaison between business leaders and various internal and external stakeholders.
Demonstrated ability to build enduring, trustworthy relationships and effectively interact across all organizational levels, both internally and externally
Capable of influencing higher-level management decisions related to large-scale tactical adjustments to organizational enhancements
Able to collaborate and work strategically in a team setting with various professional, technical, and administrative staff, integrating resources in a timely and organized manner
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.
