Provider Contracting Specialist, Principal -Medi-Cal

Blue Shield of CA; San Diego (CA); Ibrido; USD 150.000 - 190.000; Tempo pieno

Descrizione del lavoro

Blue Shield of California is seeking a senior leader in Government Programs to negotiate provider contracts across commercial, Medi-Cal, and Medicare lines, building accessible, high-quality networks.

You will lead strategy to post-contract issue resolution and cross-functional initiatives to improve affordability and member experience.

Located within 50 miles of Woodland Hills, San Diego, or Long Beach offices, this hybrid role emphasizes leadership development and growth.

Competenze

• 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

Mansioni

• Lead complex provider negotiations and manage relationships with health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members
• Own negotiations from strategy and financial evaluation through contract language, approval, execution, implementation, and post-contract issue resolution
• Lead cross-functional efforts to advance affordability, network access, product strategy, and sustainable provider partnerships while protecting the company's financial, regulatory, and member interests

Conoscenze

Provider contracting

Negotiation strategy

Medi-Cal/Medicare/Commercial Lines

Formazione

Bachelor's degree or GED with 4 years of relevant experience

Descrizione del lavoro

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.