Provider Contracting Specialist, Principal -Medi-Cal

HITEC; Long Beach (CA); Hybrid; USD 140,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking a seasoned provider contracting leader to negotiate commercial, Medi-Cal, and Medicare contracts across assigned providers and geographies. You will build and maintain high-quality, culturally responsive networks while ensuring regulatory alignment and financial sustainability.

This role owns strategy through post-contract issue resolution, leads cross-functional efforts to improve affordability, access, and member experience, and requires living within 50

Qualifications

• Bachelor’s degree or GED with 4 years of related experience.
• 10+ years provider contracting/negotiation experience.
• 5 years working with Medi-Cal, Medicare and Commercial Lines of Business.
• Must live within 50 miles of Long Beach, San Diego, or Woodland Hills offices.
• Strong written communication and ability to draft executive summaries.

Responsibilities

• Lead complex provider negotiations for commercial, Medi-Cal and Medicare lines.
• Manage relationships with health systems, hospitals, medical groups, and providers.
• Build accessible, culturally responsive, financially sustainable provider networks.
• Drive growth, quality, affordability and member-experience objectives.
• Own negotiations from strategy through post-contract issue resolution.
• Lead cross-functional efforts to advance affordability, network access and product strategy.

Skills

Negotiation leadership

Executive communication

Cross-functional collaboration

Strategic thinking

Education

Bachelor’s degree or High School Diploma/GED with 4 years of relevant experience

Job description

Your Role

The Government Programs Team Blue Shield of California and Blue Shield of California Promise Health Plan negotiating provider contracts for commercial, Medi-Cal and Medicare lines of business for assigned providers and/or geography. In this role, you will lead complex provider negotiations and manage relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. You will help build and maintain accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and advance Promise Health Plan’s growth, quality, affordability, and member-experience objectives. 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.

This role owns negotiations from strategy and financial evaluation through contract language, approval, execution, implementation, and post-contract issue resolution. The position also leads cross-functional efforts to advance affordability, network access, product strategy, and sustainable provider partnerships while protecting the company’s financial, operational, regulatory, and member interests.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

This person is required to be located within 50 miles of the Woodland Hills, San Diego, or Long Beach office locations.

Your Knowledge and Experience

• Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires at least 10 years provider contracting / negotiation experience including experience managing complex negotiations
• Requires 5 years working with Medi-Cal, Medicare and Commercial Lines of Business
• Requires this person to live within 50 miles of the Long Beach, San Diego, or Woodland Hills office locations
• 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 experience working at a health plan (managed care, government payer, or academic)
• Requires technical and functional expertise, business acumen, critical thinking, and decision-making skills
• Requires exceptional written communication skills, including the ability to draft clear, concise executive summaries that articulate negotiation strategy, planning, and execution approaches

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.