Provider Contracting Specialist, Experienced

Blue Shield of California • Long Beach, CA

6d

About The Position

Your Role The Provider Contracting team is responsible for negotiating cost-effective and competitive contracts for a variety of provider types including Cal AIM providers. The Provider Contracting Specialist, Experienced will report to the Senior Manager of Provider Contracting. In this role you will be responsible for negotiating contracts and identifying, implementing, and executing regional strategy initiatives. As well as supporting health care strategies in order to provide quality and affordable access to our members and delivering long-term sustainability in the network. 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. Responsibilities Your Work In this role, you will:

Requirements

• Requires a college degree in Business, Healthcare Policy, Public Health, or related field or equivalent experience
• Requires 3 years of prior relevant experience in Provider Contracting
• Excellent communication (oral/written) and presentation skills
• Ability to influence internal and external stakeholder discussions

Nice To Haves

• Experience with Cal AIM is preferred
• Experience with provider contracting administration, negotiation, and provider relations is strongly preferred
• Experience with and or comprehension of Medi-Cal, and Cal AIM, is preferred

Responsibilities

• Manage day-to-day contracting operations for designated Blue Shield Promise Cal AIM provider types
• Negotiate and implement provider contracts
• Collaborate closely with Medical Management, Claims, Provider Relations, and Social Services as needed
• Act as a liaison between Network Management and internal departments and/or external partners
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.)
• Review and modify contracting documents and support work that derives cost of health care savings strategies in anticipation of, and in response to, shifts in provider negotiating approaches
• Support company or department projects by researching and providing accurate information as requested by project management teams
• Demonstrate ability to multi-task with demanding timeframes
• Answer complex inquiries that require knowledge of departmental policies and procedures

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees