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Provider Contracting Specialist, Principal
3 months ago
**Your Role**
The Provider Network Management team consists of Provider Relations and Contracting in Northern California. The Provider Contracting Specialist, Principal will report to the Director, Provider Contracting. In this role you will be responsible for managing contract negotiations for select providers in Central and Northern California. The job entails comprehensive management of Medical Group/IPA and Hospital provider networks in the assigned service areas. Additionally, this role will be instrumental in driving strategic initiatives to support company objectives to achieve growth and maintain a strong market position and positive reputation in the market.
**Your Work**
In this role, you will:
- Manage contract negotiations for providers, including IPA/Medical Groups, PPO physicians, and hospitals for all products
- Participate in a cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
- Collaborate closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals
- Drive alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities
- Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.)
- Assess market trends and competitive benchmarks to enhance company’s market position
- Support initiatives to improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all employer groups
- Conduct investigations using critical thinking to understand the root cause of problems and propose solutions
- Perform other duties as assigned
**QUALIFICATIONS
Your Knowledge and Experience**
- Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
- Requires 10 years provider contracting / negotiation experience including experience managing complex negotiations
- Requires a collaborative team player approach with practical knowledge and proactive leadership and management in the execution of processes and projects within a functional team
- Requires technical and functional expertise, business acumen, critical thinking, and decision-making skills
**Pay Range**:
The pay range for this role is: $136,400.00 to $204,600.00 for California.
**Note**:
LI-JS3
ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- **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**:
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
**Physical Requirements**:
Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/
