Manager, Provider Services - Network

Your Role

The Network Performance Analysis and Contracts (NPAC) team is part of the Network Management and Provider Partnerships department and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield of California (BSC) and Promise Health Plan's (PHP) network of physicians, hospitals, ambulatory surgery centers, HMO IPAs, and medical groups. As the Manager, Provider Services – Network, you will lead a dedicated team to ensure the accurate and timely completion of all provider network regulatory filings for CMS, DMHC, DHCS, and CDI. Reporting to the Director, Provider Services – Network, your role will involve supporting ad hoc strategic evaluations, reporting, and filings as needed. Additionally, you will play a critical role in driving alignment and providing recommendations to leadership regarding the team's work, contributing to the overall success and compliance of the organization.

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:

• Lead the team to achieve the required tasks, ensuring all outputs meet the high expectations of both internal and external clients
• Support the success of the company's key strategic initiatives by ensuring the approval and expansion of provider networks with regulatory agencies (DMHC, CDI, DHCS, CMS). This is critical for the company's strategy to sell and grow in specific markets and products
• Fulfill regulatory requirements and filings, including Access and Availability, DMHC (TAR, 10% change), DHCS required filings, and Covered CA, to ensure continued marketing and sales of existing provider networks
• Assist the Director and collaborate with business partners to create a strategic vision involving analytical tools, process improvements, and product/service offerings
• Work with the team to execute the strategic vision through milestones, deliverables, and performance measurement. Identify and manage risks associated with the strategic vision
• Develop and implement short-term and long-term strategies to improve team results and meet company goals
• Lead the team to ensure all provider network regulatory filings for CMS, DMHC, DHCS, and CDI are completed accurately and on time
• Support ad hoc strategic evaluations, reporting, and filings as needed
• Collaborate with key stakeholders to manage end-to-end processes impacting provider network regulatory filings and reporting, ensuring high-quality output
• Develop and present metrics and dashboards during committee meetings
• Assist the team in identifying and implementing process improvements to support ongoing changes in the regulatory environment and requirements

Your Knowledge and Experience

• Requires a college degree or equivalent experience

• Requires 7 years of prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager

• Project management experience

• Strong knowledge of provider networks and healthcare system

• Strong interpersonal skills, ability to work effectively and build relationships with subordinates, peers, senior-level staff, cross-functional teams

• Ability to lead and influence cross-functional teams, including teams with senior-level leadership involvement or oversight

• Strong analytical, problem-solving, and critical thinking skills

• Ability to navigate ambiguous problems and breakdown complex issues into manageable chunks for structured problem-solving

• Ability to influence and drive decision making among all levels of stakeholders