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Senior Provider Network Manager, Provider Contracting Job
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| Employer Name: |
SpiderID: 13751921 |
| Location: Woodland Hills, California |
Date Posted: 5/22/2024 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17002IJ-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
• Helps develop unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve the overall competitive position and oversee an annual spend of at least $300 million and initiatives representing an additional $2M - $10M in annual cost.
• Acts as an expert go to person to other team members, ensures best practices in negotiations to achieve aggressive unit cost and overall health care cost targets and coaches less experienced network managers to improve their technical expertise.
• Helps implement department goals under the leadership of the Director of Contracting and ensures alignment of these goals with the company's broader strategic priorities.
• Continually reviews and modifies 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.
• Improves and maintains highly competitive unit costs across all products and in doing so ensures that a superior provider network is available to all employer groups.
• Negotiates independently with minimal guidance from the Director to achieve negotiation results with the most complex providers.
• Utilizes strong analytical skills and tools to achieve success in negotiation results.
• Helps implement department goals under the leadership of the Contracting Executives and ensures alignment of these goals with the company's broader strategic priorities
Qualifications:
• Demonstrated track record of change leadership including executive influencing skills
• Requires 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 exposure
• Excellent oral and written communication skills
• Bachelor's degree in Business, Healthcare Policy, Public Health or related field a must plus, at least 10+ years provider contracting experience at a senior negotiator level or 7+ years with a Master's degree
• Substantial experience in managing complex and high-profile provider negotiations independently
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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