Director, Network Operations — Hybrid, Data-Driven Provider Contracts

Blue Shield of California; California (MO); Hybrid; USD 170,000 - 256,000; Full time

Job summary

Blue Shield of California seeks a Director, Network Operations to lead cross-functional teams across finance, actuarial, clinical, and operations. You will design and execute strategic network roadmaps, optimize provider contracts, and drive cost-effective healthcare initiatives in alignment with enterprise goals.

The role emphasizes data-driven decision making, governance, and collaboration with the Network Strategy team to advance affordability and growth across Blue Shield California and its

Qualifications

• Bachelor’s degree required; MBA/MPH/MHA preferred.
• 10+ years of experience in health plan operations, including data analytics and project management.
• 6+ years of management experience.
• Lean Six Sigma or PMP certification preferred.
• Experience structuring execution across complex programs with cross-functional teams.
• Knowledge in provider contracting, regulatory compliance, and end-to-end health plan operations.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication with stakeholders at all levels.

Responsibilities

• Lead cross-functional initiatives with finance, actuarial, clinical, and operations teams to align policies with optimal contract terms.
• Design and implement Network Operations departmental goals and execution plans.
• Collaborate with Network Strategy to create roadmaps supporting affordability and growth.
• Identify provider contract exposure points and design mitigation strategies.
• Apply modeling and analytics to assess contract performance and total cost of healthcare.
• Drive data-driven strategies to optimize provider network performance.
• Address risks affecting network resiliency, access, and member experience.
• Document and maintain policies, procedures and governance structures.
• Strategize with internal stakeholders on system and process enhancements.
• Communicate updates and risks to leadership and governance committees.
• Foster collaborative relationships to reduce silos with key partners.

Skills

Bachelor's degree

MBA/MPH/MHA

Health plan ops

Management experience

Lean Six Sigma Black Belt

Regulatory knowledge

Education

Bachelor’s degree

Advanced degree (MBA/MPH/MHA)

Job description

Blue Shield of California seeks a Director, Network Operations to lead cross-functional teams across finance, actuarial, clinical, and operations. You will design and execute strategic network roadmaps, optimize provider contracts, and drive cost-effective healthcare initiatives in alignment with enterprise goals.

The role emphasizes data-driven decision making, governance, and collaboration with the Network Strategy team to advance affordability and growth across Blue Shield California and its