VP, Provider Network Management Job

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:

Reporting to the SVP, Provider Network Management, the role of VP, Provider Network Management contributes to Blue Shield's overall strategy and goals by providing consistent leadership to the Provider Contracting and Provider Relations teams statewide and ensures interconnected performance with other teams and divisions. This is the central role responsible for the oversight and execution of our provider contracting roadmap, ACO network expansion and maintenance, and provider related strategies. This role is responsible for ensuring Blue Shield's overall provider network meets the quality and affordability goals, helping achieve our overall cost of health care unit cost goals, execute on cost of health care initiatives, partner with the ACO team to collaborate and enhance ACO relationships, improve access and availability and meet network access requirements by various regulatory agencies.

The VP, Provider Network Management provides direction to the contracting and provider relations teams who are managing a portfolio of providers within their regional teams designed to improved affordability and quality of care with our provider network and deepen ACO provider partnerships. In this highly visible role, the VP is also responsible for developing and maintaining excellent relationships with leaders from Blue Shield's provider partners, regulators and industry collaborators. Additionally, the VP, Provider Network Management is responsible for providing strategic and operational leadership in executing our provider network strategy with hospitals, medical groups, IPAs, ASCs, SNF's, and health systems. The VP is also responsible for collaboratively enhancing Blue Shield's contracting capabilities through the development of strong relationships within HCQA, and being interconnected with teams including actuary, finance, medical informatics, product, and markets/sales/account teams.

Specific Responsibilities Include:

• Provide strategic leadership and mentoring to the Contracting and Provider Relations teams, building a high-performing team that meets all operating goals, including cost of health care, regulatory, compliance, administrative costs and employee engagement.
• Manage increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.
• Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the enterprise strategy.
• Foster a culture of innovation and creativity to enable Blue Shield of California's ACO strategy to meet changing market conditions.
• Continuously partner with providers to influence and improve provider performance around access and availability, quality and affordability.
• Instill a culture of continuous process improvement and innovation (Lean Sigma).
• Initiate, nurture and maintain effective channels of communication with matrix partners including but not limited to Actuary, Finance, Medical Informatics, Product, and Markets/Sales/Account teams.
• Manage strategic positioning for provider contracting, develop networks and identify and act upon opportunities for greater value-orientation and risk arrangements.
• Continuously track the managed care environments to identify and implement innovative approaches to improving upon value-based reimbursement methods.
• Administrative budget planning, forecasting and tracking.

Qualifications:

Minimum Education & Experience Requirements :

The VP, Provider Network Management will be a highly talented executive with deep experience in provider partnership, provider contracting, and provider relations in a managed care setting. The successful candidate will be an outstanding leader, with the ability and desire to think creatively and innovatively. The VP will have demonstrated the ability to deliver consistent superior results in unit cost management, quality, financial management, and employee engagement. The successful candidate will thrive in a mission and results driven organization.
• Bachelor's degree required; Area of focus in Finance, Economics, Healthcare or Business related strongly preferred.
• 15+ years of contracting and negotiating experience involving complex delivery systems and organizations required.
• Prior experience managing direct reports and leading project teams in a geographically-dispersed work environment required
• Experience in developing and managing key provider relationships including senior executives.
• Experience with all managed-care products, including commercial, marketplace, Medicare and Medicaid.
• Knowledge of complex reimbursement methodologies, including incentive based models required.
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
• Specialized knowledge of California health care market dynamics, key provider organizations and contracting/compensation models.
• Proven project management experience applying industry methodologies and practices.
• Intimate understanding and experience with larger, more complex integrated delivery systems, managed care, and provider business models.

Preferences :
• MBA or MHA degree preferred

KNOWLEDGE and SKILLS:

• Broad and deep health care strategy and overall industry knowledge, and understanding of the California health care landscape
• Team player with proven ability to work cross-functionally and develop strong collaborative working relationships within a fast-paced, matrix organization
• Demonstrated ability to build high-performing teams, and lead and manage organizations through significant change
• Ability to think strategically and act tactically
• The ability to influence both sales and provider audiences through strong written and verbal communication skills
• Excellent presentation skills
• Demonstrates managerial courage and change leadership in a dynamic environment
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
• Technologically savvy and able to utilize information systems effectively