Sr. Director, Provider Partnerships

Blue Shield of California•Oakland, CA

About The Position

Your Role 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, Performance Enablement in the Network Management and Provider Partnerships department. In this role you will lead in a highly matrixed environment across multiple internal business teams to provide strategic alignment, business planning, and effective execution of the provider engagement and enablement plans for all providers in your portfolio for all lines of business. The outcome of being the ideal partner to our providers will be a material improvement to quality and service, affordability and growth in membership in service to our communities 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 college degree or equivalent experience
Requires 12 years of prior relevant experience, including 6 years of management experience which encompasses experience building high-performing teams
Deep expertise in complex provider models, contract structures, and market-specific financial responsibility frameworks (e.g., California delegated models)
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
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
Demonstrated ability to mentor and coach, lead through large-scale change, collaborate and build trusting relationships with provider partners and key internal stakeholders
Demonstrated execution orientation with measurable outcomes and accountability
Proven executive provider engagement experience and the ability to manage multiple complex provider relationships at a time, and experience applying industry methodologies and practices
Ability to be technological and data savvy; and ability to utilize information systems effectively

Nice To Haves

Knowledge of healthcare utilization metrics is strongly preferred

Responsibilities

Lead cross-functional teams to build and strengthen 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
Build and execute a provider engagement and enablement strategy to improve provider satisfaction with BSC and overall provider wellness, clinical quality performance, member experience, operational performance, including access to care, affordability (for providers and BSC), and practice sustainability
Take an end-to-end holistic view of providers in your portfolio to ensure all BSC efforts are aligned and support our strategy
Work cross-organizationally with internal departments and provider partners to ensure provider engagement and enablement plans are delivering, partnering with other cross-functional teams to ensure all efforts with a provider are tracked and coordinated to enhance the provider experience, and managing a team of program managers to effectively measure performance and success within the region
Collaborate with Network Management to understand and ensure there is an aligned network strategy, and support contracting efforts and negotiations
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