Manager, Provider Services - Network

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 Network Performance Analysis and Contracting (NPAC) team focuses on provider network performance analysis, reporting, and consulting. The Manager, Network Performance will report to the Senior Manager, Network Performance. In this role you will lead a team responsible for the reporting and monitoring of our key provider networks as they are responsible for critical regulatory reporting, performance reporting, provider network strategic planning, and delivering outstanding analytic and consultative service to HCQA and other organizations like Legal, Sales, and Product. The team works cross-functionally with other key stakeholders ensuring our reporting processes evolve as the regulatory space and enterprise does and coordinates as needed to ensure reporting & monitoring needs are met while always looking for efficiency gains and opportunities for process improvement.

Your Work

In this role, you will:

• Lead the team to meet the required tasks and ensure all output meets the high expectations of internal and external clients
• Regulatory/Network Filing/Network Design: support the success of the key critical strategy of the company and ensure the approval of new and expansion of the provider network(s) with the regulatory agencies (DMHC, CDI & CMS) (this is critical for BSC strategy to sell and grow in certain markets and products); fulfill regulatory requirements, reporting and filings: Access and Availability, DMHC (TAR, 10% change), DHCS Annual Network Certification, CMS HSD table development, CDI Reporting, Covered CA which will ensure that we can continue to market and sell existing provider networks.
• Assist Network Leadership and collaborates with business partners to create the strategic vision involving analytical tools, process improvements, and product/service offerings
• Work with team to execute the strategic vision via milestones, deliverables, and performance measurement. Identifies and manages risks associated with the strategic vision
• Develop and implement short-term and long-term strategies to improve team results and meet company goals
• Manage professional development and direction of team to ensure high performing team, foster inclusivity and team-oriented environment