Job Description***This is a Short Term Employment opportunity that has the ability to be employed up to a maximum of 3 years***Your RoleThe Provider Contracting team is responsible for contract negotiations, coordination, and ongoing support and interpretation of contracts for both internal and external partners. The Provider Contracting Specialist, Consultant will be responsible for negotiating provider agreements and accountable care collaboration agreements with medical groups/IPAs, hospitals, and ambulatory surgery centers. Reporting to the Director, Provider Contracting & Provider Relations, this role will drive strategic initiatives to support Blue Shield of California's objectives to achieve growth and maintain strong market position and positive reputation in the market.Your WorkIn this role, you will:
- Negotiate all product (commercial, Medicare, and Medi-Cal) provider agreements with medical groups/IPAs, hospitals, freestanding ambulatory surgery centers and accountable care collaboration agreements
- Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
- Collaborate closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals
- Drive alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities
- Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.)
- Assess market trends and competitive benchmarks to enhance company's market position
- Conduct extensive investigation and apply critical thinking to understand root functions and/or businesses to develop new perspectives and innovative approaches on existing or new problems, and communicate with external customers and vendors on new concepts, practices, and approaches
- Take responsibility for managing large, complex project initiatives of strategic importance to the organization, involving cross-functional teams
- Frequently be responsible for providing guidance, coaching, and training to other employees across the company within area of expertise
- Communicate with executive leadership regarding matters of significant importance to the organization, including writing comprehensive executive summaries
Qualifications
Your Knowledge and Experience- Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
- Requires at least 7 years provider contracting / negotiation experience including experience managing complex negotiations
- Requires broad healthcare industry knowledge with substantial experience negotiating and managing complex, high-profile provider contracts
- Requires advanced knowledge and skills including technical or functional expertise, business acumen, financial analysis, risk management, delegation, critical thinking, and decision making
- Requires excellent oral and written communication skills
Pay Range:The pay range for this role is: $109,120.00 to $163,680.00 for California.
Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-MM4About the TeamBlue 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 genuinely 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 continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values: - Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
- Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an Essential Role, the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail.
Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.