Sr. Manager, Provider Contracting

Your Role

The Network Management team consists of Contract Negotiators and Provider Relations in the Central Valley. The Sr Manager, Provider Contracting will report to the Director, Provider Contracting. In this role you will lead contracting specialists managing provider issues, contract process, contracting questions, and project assignments. 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:

• Primarily manage contract negotiations with Hospital and Provider Group capitation in the Central Valley

• Drive unit cost trend targets and specific metric improvements within contract negotiations 

• Participate in or lead cross functional teams to implement initiatives to help manage the total cost of health care across the assigned region and manage larger strategic initiatives across regions or statewide

• Work closely with the internal departments to ensure best practices operationally through negotiations to achieve aggressive unit cost and overall health care cost targets

• 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

• Improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all employer groups

• Participate and collaborate in discussions around development and/or implementation of provider networks

• Collaborate with internal departments on best practices for aligned communications to providers; which may include improved processes and tools

Your Knowledge and Experience

• Requires a college degree or equivalent experience

• Requires 10 years provider contracting experience at a senior negotiator level, including at least 4 years of people management experience at a health plan or in a provider organization

• Requires substantial experience in managing complex and high-profile provider negotiations

• Requires practical knowledge in leading and managing the execution of processes, projects and tactics within an area

• Advanced knowledge and skills including technical or functional expertise, business acumen, financial analyses skills, risk management, delegation skills, critical thinking and decision making skills

• In-depth knowledge of Blue Shield of California’s mission, vision and strategy and healthcare industry environment

• Comprehensive understanding of contracting practices for hospital and cap arrangements with both provider groups and hospitals