Director, Provider Network Operations

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

Job Description

The Network Operations team sets the strategic direction for operational processes, network compliance, contract operations, and provider relations for Blue Shield and Blue Shield Promise Health Plan. This work ensures provider contract alignment, supports financial stewardship, strengthens enterprise governance, and advances strategic priorities across multiple lines of business. Reporting to the Vice President, Network Operations, the Director, Network Operations plays a leadership role, guiding data-driven contracting approaches to improve provider network effectiveness while aligning and executing operational initiatives and governance to serve Blue Shield of California and Blue Shield of California Promise Health Plan's (collectively “Blue Shield”) best interests. This position works closely with the Vice President of Network Operations to establish priorities while designing a comprehensive execution plan that effectively integrates each of the areas within the department. The Director will collaborate with multiple areas within the organization to design and implement roadmaps leading to efficient cost of healthcare strategies.

We are actively recruiting candidates within 50 miles of our BSC offices in Woodland Hills, Long Beach, and San Diego ONLY.

Responsibilities

In this role, you will:

• Lead cross-functional initiatives and teams involving finance, actuarial, clinical, and operations teams to ensure policies and procedures are aligned with optimal contract terms


• Develop and design the implementation of the overall Network Operations departmental goals and execution plans aligned with organizational strategy


• Partner closely with the Network Strategy team to design Network Strategic & Operational roadmaps to support enterprise affordability & growth goals


• Identify provider contract exposure points, inclusive of language and rate structures, and then design and implement operational and contractual mitigation strategies


• Apply advanced modeling and analytical frameworks to assess contract performance and efficient management of total cost of healthcare


• Provide leadership to drive data-driven strategies to optimize provider network performance and align with organizational goals


• Proactively assess and address risks impacting network resiliency, provider accessibility, and member experience, reinforcing long-term stability and operational efficiency


• Lead the documentation and maintenance of policies, procedures, and governance structures to support high-quality, timely and compliant deliverables


• Partner with internal stakeholders to strategize and prioritize system and procedural enhancements


• Communicate updates, risks, and strategic recommendations to leadership and governance committees


• Actively participate in collaborative, trusting peer relationships helping to drive the organization to reduce silos with key business partners.


• Integrate and optimize business processes across Provider Partnerships and Network Management in support of the Blue Shield strategic and operational needs


• Role model collaborative, trusting peer relationships; drive through organization to reduce silos with key business partners.

Qualifications

• Requires a Bachelor’s degree required; advanced degree preferred (MBA, MPH, MHA)


• Requires a minimum of 10 years’ experience in health plan operations, including data analytics and project management


• Requires 6 years of management experience


• Lean Six Sigma process improvement certification (Black Belt preferred) or Project Management Professional (PMP) certification strongly preferred or equivalent training and experience


• Proven ability to structure execution across complex programs and initiatives with cross-functional teams


• Requires knowledge in provider contracting, regulatory compliance, and end-to-end health plan operations


• Requires excellent analytical, organizational, and problem-solving skills


• Requires excellent written and verbal communication skills with a proven track record in effective relationship building and influencing stakeholders at all levels of the organization

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.


• 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

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.


• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.


• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Job Info

Job Schedule : Full time

Locations :

Long Beach, CA, United States

CA, United States

San Diego, CA, United States

Woodland Hills, CA, United States

Pay Range for California : $170280.00 to $255530.00

Pay Range for Bay Area : $191952.00 to $288052.00

Role can be filled by a candidate requiring sponsorship : No