Provider Contracting Specialist, Principal -Medi-Cal
About The Position
The Provider Contracting Specialist, Principal - Medi-Cal, is part of the Government Programs Team at Blue Shield of California and Blue Shield of California Promise Health Plan. The role leads complex provider negotiations and manages relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. It helps develop accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and support growth, quality, affordability, and member experience. 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 related to affordability, network access, product strategy, and sustainable provider partnerships while protecting the company’s financial, operational, regulatory, and member interests. The role is located within 50 miles of the Woodland Hills, San Diego, or Long Beach office locations and follows a hybrid workplace model, generally requiring in-office work two days each week for most teams.
Requirements
- Bachelor’s degree, or a High School Diploma/GED and 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.
- 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, such as managed care, a government payer, or an academic organization.
- Technical and functional expertise, business acumen, critical-thinking, 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 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.
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What This Job Offers
Job Type
Full-time
Career Level
Principal
