Provider Contracting Specialist, Principal -Medi-Cal

Blue Shield of California • Woodland Hills, CA

8d • Hybrid

About The Position

The Provider Contracting Specialist, Principal, works on the Government Programs Team for Blue Shield of California and Blue Shield of California Promise Health Plan, negotiating provider contracts for commercial, Medi-Cal, and Medicare lines of business. The role leads complex negotiations and manages relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. It supports the development and maintenance of accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and advance growth, quality, affordability, and member-experience objectives.

The position owns negotiations from strategy and financial evaluation through contract language, approval, execution, implementation, and post-contract issue resolution. It also leads cross-functional efforts that advance affordability, network access, product strategy, and sustainable provider partnerships while protecting the company’s financial, operational, regulatory, and member interests. The role is expected to support strategic initiatives that advance company objectives, growth, market position, and reputation.

The position requires the employee to live within 50 miles of the Woodland Hills, San Diego, or Long Beach office locations. It follows a hybrid workplace model; for most teams, this means working in the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business needs.

Requirements

• Bachelor’s degree, or a high school diploma/GED plus four years of additional relevant experience in lieu of a degree.
• At least 10 years of provider contracting or negotiation experience, including experience managing complex negotiations.
• Five years of experience working with Medi-Cal, Medicare, and commercial lines of business.
• Must live within 50 miles of the Long Beach, San Diego, or Woodland Hills office locations.
• Collaborative team-player approach, with practical knowledge and proactive leadership and management in executing processes and projects within a functional team.
• Experience working at a health plan, including managed care, government payer, or academic experience.
• Technical and functional expertise, business acumen, critical-thinking skills, and decision-making skills.
• Exceptional written communication skills, including the ability to draft clear, concise executive summaries that articulate negotiation strategy, planning, and execution approaches.

Responsibilities

• Lead end-to-end negotiations and remain accountable for timely execution of contracts with complex provider organizations across assigned providers and markets.
• Develop and execute negotiation strategies, business cases, term sheets, and executive recommendations informed by provider, market, and competitive dynamics.
• Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, and Sales to advance affordability, growth, and regional objectives.
• Identify and drive network and unit-cost opportunities that strengthen market position and maintain a competitive provider network.
• Support cross-functional initiatives to manage total cost of care and improve performance across assigned regions and products.
• Investigate and resolve complex issues by identifying root causes and implementing practical solutions.
• Meet critical negotiation, approval, contract execution, and implementation timelines with urgency and accountability.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Principal