Manager, Provider Contracting

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 Provider Contracting team is responsible for Medical Group/IPA and Hospital contracting in Northern California and driving strategic initiatives to support Blue Shield’s objectives to achieve growth and maintain strong market position and positive reputation in the market. The Manager, Provider Contracting (MPC) will report to the Senior Manager, Provider Contracting. In this role you will manage a statewide team of Provider Contract Letter of Agreement (LOA) Specialist that negotiate single case/member specific LOAs with medical groups, hospitals, ancillary, physicians, specialists, dentists, freestanding surgery centers, skilled nursing facilities, PPO, specialty benefits, and others. MPC participates in cross functional work teams, projects, and meetings for providing input into developing and implementing new or improved LOA processes and tools. MPC educates/communicates with other departments across the enterprise on the role, responsibility, and scope of the LOA team regarding provider contracting.. 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.

Your Work

In this role, you will:

• Help develop unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve overall competitive position.
• Work closely with the contracting team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets.
• Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities.
• Improve and maintain highly competitive unit costs across all products and in doing so will ensure that a superior provider network is available to all employer groups.
• Provide strong and focused leadership to the negotiating team directly accountable for achieving department metrics.
• Have overall hiring, firing, promotion, and reward authority within own department, in accordance with organizational guidelines.
• Plan and establish goals and objectives for the LOA team in partnership with the Senior Manager/Director.
• Work collaboratively with other functional areas and communicate/educate other departments on the role, responsibility and scope of LOA team’s provider contracting efforts and its interaction with Blue Shield’s overall provider contracting strategy.
• Lead, direct, and review the work of team members to accomplish LOAs within established timelines and financial parameters.
• Generate monthly and quarterly reporting of LOA activity and prepare semi-annual comprehensive network analysis to identify gaps in network for members’ access to care, as well as provider network adequacy, and report on LOA spend where contracted alternatives are available.