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October 20 2017

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Senior Provider Network Manager

Blue Shield of CaliforniaLos Angeles, CA10/12/2017
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Job Description

Looking for a chance to do significant work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making Information technology more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net earnings to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Job Requirements

•Helps develop unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve the overall competitive position and supervise an annual spend of at least $300 million and initiatives representing an additional $2M - $10M in annual cost.
•Acts as an expert go to person to other team members, ensures best practices in negotiations to achieve aggressive unit cost and overall health care cost targets and coaches less practiced network managers to improve their technical skills.
•Helps implement department goals under the leadership abilities of the Director of Contracting and ensures alignment of these goals with the company's broader strategic priorities.
•Continually reviews and modifies contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities.
•Improves and maintains highly competitive unit costs across all products and in doing so ensures that a superior provider network is available to all employer groups.
•Negotiates independently with minimal guidance from the Director to achieve negotiation results with the most complex providers.
•Utilizes strong analytical skills and tools to achieve success in negotiation results.
•Helps implement department goals under the leadership abilities of the Contracting Executives and ensures alignment of these goals with the company's broader strategic priorities

•Demonstrated track record of change leadership abilities including executive influencing skills
•Requires broad health care strategy and overall industry expertise
•Superior technical skills in provider contracting strategy, reimbursement methodologies and provider network analysis
•Broad business skills including analysis of strategic alternatives, financial impact analysis and sales exposure
•Excellent oral and written communication skills
•Bachelor's degree in Business, Healthcare Policy, Public Health or related field a must plus, at least 10 years provider contracting practice at a senior negotiator level or 7 years with a Master's degree
•Substantial practice in managing complex and high-profile provider negotiations independently

Job Snapshot

Employment Type Full-Time
Job Type Management
Education 4 Year Degree
practice Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 17002IJ

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Company Overview

Blue Shield of California
Take the Well-Being Assessment and get a personalized report about your current well-being and how you can improve it. Then, depending on your membership, you can explore other programs like everyday Challenge and QuitNet to get you started.Your wellness matters, and we offer a wide variety of discount programs to help you save money and get healthier. Save on gym membership fees and access free personal training sessions, receive nutrition support, explore alternative care options and more.
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Los Angeles, CA
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Job Category: Customer Service [ View All Customer Service Jobs ]
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Salary: Unspecified
Degree: Unspecified
Experience (year): Unspecified
Job Location: Other
Company Type Employer
Post Date: 10/13/2017 / Viewed 4 times
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