Sr. Director, Provider Partnerships

Blue Shield of California•Oakland, CA

2d•$201,960 - $341,620•Hybrid

About The Position

The Provider Partnerships team is responsible for creating high integrity relationships with medical providers to enable Blue Shield of California (BSC) to be the health plan of choice. The Sr. Director, Provider Partnerships will report to the Vice President Network Strategy in the Network Management and Provider Partnerships department. In this role you will provide strategic leadership across a highly matrixed environment, aligning multiple internal business functions, and partnering around shared priorities and measurable outcomes. You will effectively execute the provider engagement plans in alignment with enterprise and local market regional priorities for health systems and IPA/Medical Groups for all lines of business. This role serves as a critical connector between BSC and its provider network, translating organization strategies into actionable provider initiatives that advance affordability, quality, clinical performance, access, growth, and overall provider and member experience, across all lines of business. 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.

Requirements

Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
Requires 12 years of prior relevant experience
Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
Requires deep expertise in complex provider models, contract structures, and market-specific financial responsibility frameworks (e.g., California delegated models)
Requires strong experience and orientation to the quadruple aim coupled with knowledge of markets, health plan operations, product development, network management, clinical operations, finance, regulatory issues, and compliance in the healthcare industry
Requires proven executive provider engagement experience and the ability to manage multiple complex provider relationships at a time, and experience applying industry methodologies and practices
Requires demonstrated execution orientation with measurable outcomes and accountability
Requires demonstrated ability to mentor and coach, lead through large-scale change, collaborate and build trusting relationships with provider partners and key internal stakeholders
Requires strong leadership skills including excellent interpersonal, communications, problem solving and negotiating skills, the ability to think strategically while at the same time drive operational performance, and the ability to effectively work cross-functionally and collaboratively across BSC at all levels of the organization
Requires technological and data savvy and the ability to utilize information systems effectively

Nice To Haves

Knowledge of healthcare utilization metrics is strongly preferred

Responsibilities

Support Vice President of Network Strategy in the development and execution of comprehensive, multiyear regional partnership strategy aligned with enterprise priorities for affordability, quality, access, growth, provider and member experience across all lines of business. Build, strengthen and maintain trusting relationships with providers to work together to deliver care worthy of our family and friends
Provide thought leadership and collaborate with all applicable business teams, including the Performance Enablement Program team, to co-develop performance and engagement strategy and goals, sharing accountability for P&L and membership growth results including expansion efforts, clinical performance, and cost of healthcare
Influence enterprise decision-making through regional market expertise and data-driven insight, recommendations, and visibility into regional provider performance, strategic opportunities, and material risks
Identify, shape and advance innovative provider partnerships and network strategies, including high-value networks, differentiated access models, and other solutions that improve affordability, quality, access, growth and positive outcomes
Establish and strengthen long-term strategic relationships with health systems, IPA/Medical Groups and other priority providers, fostering collaboration, performance, accountability, affordability and quality improvement, and effective total cost-of-care management
Lead and influence cross-functional collaboration across internal departments and provider partners to drive strategic provider engagement initiatives that achieve measurable business outcomes
Oversee the planning, execution, and continuous optimization of engagement strategies, ensuring seamless coordination, enhanced provider experiences, and strong regional performance
Direct and develop a team of program managers, establishing clear accountability, performance metrics, and data-driven insights to evaluate success, identify opportunities for improvement, and advance organizational goals
Understand and capitalize on the competitive market and identify opportunities for the provider strategy accordingly
Drive the financial performance of your portfolio supported by the Finance Team (planning, reporting, performance management, contract support, capitation payments, analysis, coding and budgeting)
Foster a culture of innovation and creativity to enable BSC to meet changing market conditions and strategy
Build a high-performing team that meets all operating goals, including cost of healthcare, clinical quality improvement, regulatory compliance, administrative cost, and employee engagement