Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The PPO Professional Provider Contracting team manages our PPO network to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. The Provider Contracting Specialist Sr. will report to the Provider Contracting Manager. In this role you will ensure the acquisition, servicing and performance of Physicians/Medical Groups and other Specialty Network Providers to the Blue Shield of CA contracted network. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensures alignment of these goals with the company's strategic priorities. Supports review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches. Research opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assesses market trends to drive initiatives which enhance company's market position. Other duties as assigned. .

Your Work

In this role, you will:

• Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region


• Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals


• Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities


• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.)


• Assess market trends and competitive benchmarks to enhance company's market position


• Negotiate and finalize Independent Provider Agreements including value-based payment models for primary care and other specialty network contracts based upon network analysis and established parameters as directed by Director of Provider Contracting and/or Provider Contracting Manager.


• Manage contracting efforts through entire procurement process (end to end) to ensure contracts are administered and implemented accurately.


• Assist with recruitment strategies for targeted providers.


• Collaborate with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets
  
  

Your Knowledge and Experience

• Requires a bachelor's degree in business, healthcare policy, public health or related field


• Requires at least 3 years provider contracting / negotiation/ provider relations experience including experience managing complex negotiations


• Strong analytical and problem-solving skills.


• Excellent interpersonal, oral and written communication skills


• Health care industry/provider network knowledge including data analysis, understanding of provider contract language including provider reimbursement methodologies etc.


• Ability to develop, organize, analyze, and implement processes and procedures


• Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure

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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes


• 
  Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals
  
  

Additional Information

• About Company:
  o About Blue Shield of California: For more than 80 years, Blue Shield has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 7,500 employees, more than $21 billion in annual revenue and 4.5 million members. The company has contributed more than $500 million to the Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield is headquartered in Oakland, California with 21 additional locations including Sacramento, Los Angeles, and San Diego.
  o Our Benefits: At Blue Shield you can expect a comprehensive benefits program that offers choice and flexibility for our diverse workforce. These programs and resources include: Medical, Dental, and Vision plan benefits, 401(k) with employer match, paid time off (PTO), earned sabbatical time, paid nonprofit volunteer time, flexible work program, free online education, tuition reimbursement, a wellness reimbursement program, 12 weeks paid parental leave, and more.










• 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.
















• EEO Footer:
  o EEO Footer: 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. 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.
  o Accommodations: Blue Shield is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, services, programs and activities. To request a reasonable accommodation prior to your interview, please contact RehabWest, Inc at (760)759-7500.











• Requisition ID: 21002J2













• Posting Date: Oct 20, 2021











• Schedule: Full-time

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