Provider Network Negotiator

4 weeks ago


Woodland Hills, California, United States Blue Shield Of California Full time

Welcome to Blue Shield of California

About Our Mission

We strive to make a positive change across our industry and communities. Our mission is to ensure all Californians have access to high-quality healthcare at a sustainably affordable price. We achieve this by transforming healthcare through lowering costs, improving quality, and enhancing the member and physician experience.

Salary Range: $109,120.00 - $163,680.00

Your Job Description

This role involves negotiating provider agreements and accountable care collaboration agreements with medical groups/IPAs, hospitals, and ambulatory surgery centers. You will work with cross-functional teams to implement initiatives that help manage the total cost of healthcare across assigned regions. Your responsibilities will include:

  • Negotiating product (commercial, Medicare, and Medi-Cal) provider agreements with medical groups/IPAs, hospitals, freestanding ambulatory surgery centers, and accountable care collaboration agreements.
  • Collaborating closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals.
  • Driving alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities.
  • Identifying strategic opportunities within local markets.
  • Assessing market trends and competitive benchmarks to enhance company positioning.

Requirements

  • A college degree in Business, Healthcare Policy, Public Health, or related field or equivalent experience.
  • A minimum of 7 years of prior relevant experience.
  • Broad healthcare industry knowledge with substantial experience negotiating and managing complex, high-profile provider contracts is preferred.
  • Advanced knowledge and skills including technical or functional expertise, business acumen, financial analysis, risk management, delegation, critical thinking, and decision-making is preferred.
  • Excellent oral and written communication skills is preferred.


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