Director, Commercial Provider Accounts

Your Role

The Provider Contracting team is responsible for managing Provider Contracting for provider systems, along with independent hospitals, and medical groups/IPAs in Southern California. The Director, Provider Contracting will report to the Vice President, Provider Contracting. In this role you will lead a high performing team of contracting specialists in managing contracting for portions of Southern California to support up to $4-5 billion in annual spend. Additional responsibilities include leading and participating in strategic initiatives including, but not limited to, network expansion, Accountable Care Organization performance, and cost of healthcare savings opportunities. 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:

• Assist in developing unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve overall competitive position and oversee an annual spend of approximately $4-5B
• Work closely with other contracting teams to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets, as well as contractual compliance with government relations
• Continually review and modify 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, and oversee an operating budget of approximately $2M
• 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
• Set up Blue Shield and Growth and Health Solutions for long term success through critical organizational initiatives
• Role model collaborative, trusting peer relationships; drive through organization to reduce silos with key business partners
• Support the Markets organization in the support and acquisition of key employer accounts
• Work with the team to hone leadership skills as well as negotiating skills and technical expertise and help the team develop their ability to optimally utilize internal and external analytical (and other) tools to effectively manage negotiations
• Identify and develop best in class talent

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 10 years provider contracting experience at a senior negotiator level
• Requires 6 years of people management experience at a health plan or in a provider organization
• Understanding of the California healthcare market strongly preferred
• Broad and deep health care strategy and overall industry knowledge, and understanding of the California health care landscape including in-depth understanding of provider reimbursement methodologies and provider contract language
• Superior technical skills in provider contracting strategy, reimbursement methodologies and provider network analysis, and excellent negotiation and conflict-resolution skills
• Excellent verbal, written, and presentation skills with the ability to convey complex information in a manner that others can understand at all levels of the organization
• Demonstrated leadership, change management, collaboration, coaching and mentoring skills