Provider Contracting Specialist, Consultant

Blue Shield of California • Rancho Cordova, CA

6d • Hybrid

About The Position

The Provider Contracting Specialist, Consultant is part of the Provider Network Management team, which is responsible for provider contracting and network performance across California. The role executes an assigned portfolio of provider negotiations and contracting initiatives within statewide strategies, governance standards, priorities, and escalation frameworks established by contracting leadership.

The specialist independently manages complex provider negotiations and contracting initiatives from strategic and financial analysis through execution, implementation, and issue resolution. The role partners across the organization to advance affordability, network access, and business objectives while following established contracting strategies, policies, controls, and approval requirements. The specialist is accountable for timely execution and portfolio performance, proactively identifying risks and escalating issues that require broader policy, resource, or executive decisions.

This is a hybrid role. Employees are expected to work in-office according to the hybrid workplace model, which for most teams means two days each week. Employees living more than 50 miles from an office location will determine in-office time with their manager based on business need.

Requirements

• Bachelor’s degree, or High School Diploma/GED and four years of additional relevant experience in lieu of a degree.
• Seven years of prior relevant experience.

Nice To Haves

• Previous provider contracting and negotiation experience, including managing complex negotiations and provider contracting processes.
• Advanced working knowledge of provider contracting, reimbursement methodologies, provider contract language, financial impact analysis, and provider network management.
• Working knowledge of managed care operations and the financial, operational, legal, regulatory, and member implications of provider agreements.
• Demonstrated ability to interpret data, evaluate alternatives, develop negotiation strategies, and translate analysis into practical recommendations.
• Strong project and portfolio-management skills, including managing multiple negotiations, milestones, dependencies, and competing priorities.

Responsibilities

• Lead assigned provider negotiations and renewals through contract execution and implementation, within established strategy, financial parameters, and approval requirements.
• Develop negotiation strategies, financial analyses, business cases, term sheets, and contract recommendations for assigned providers, with appropriate leadership review and approval.
• Manage assigned contracting activities, milestones, risks, dependencies, and implementation requirements to support timely and accurate execution.
• Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, Legal, Operations, and Sales to support affordability, network, and business objectives.
• Identify network, reimbursement, utilization, and unit-cost opportunities within assigned providers and recommend practical actions to contracting leadership.
• Investigate and resolve provider, contract, and implementation issues within delegated authority; identify root causes and escalate material risks, policy questions, or barriers as appropriate.
• Apply established contracting policies, procedures, templates, controls, and approval requirements consistently across assigned work.
• Meet negotiation, approval, contract execution, and implementation commitments with urgency, sound judgment, and accountability.

What This Job Offers

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