Sr. Medical Director, Provider Performance

Blue Shield of California•Woodland Hills, CA

3d•Hybrid

About The Position

The Senior Medical Director, Provider Performance, sits at the center of Blue Shield of California’s efforts to elevate provider performance, clinical quality, and affordability across its entire Commercial network. The incumbent partners closely with Provider Performance, Network Management/Contracting, and internal/external partners to drive measurable provider performance improvements, while supporting key external Commercial clients. This role blends strategic influence with real execution— leading performance improvement for some of the most complex health systems while shaping network strategy, supporting contracting efforts, and delivering on the BSC mission statements. 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

MD or DO degree required
10 years of managed care experience required
5 years of clinical experience required
2 years of previous medical leadership experience required
Completed residency, preferably in adult-based primary care specialty (e.g. internal medicine, family practice)
Active, unrestricted California State Medical License
Demonstrated experience executing provider performance initiatives
Demonstrated ability to manage multiple complex initiatives simultaneously

Nice To Haves

master’s degree in healthcare, public health, business, or related field preferred (MPH, MBA, MHA, etc.)
Experience coordinating cross-functional, clinical, and data-oriented projects, in a matrixed environment preferred

Responsibilities

Provide strategic clinical leadership for provider performance & network strategy across all provider types, including IPAs, medical groups, hospitals, and integrated delivery systems spanning PPO, HMO, ACO, and other risk-based arrangements
Partner closely with enterprise partners to design, prioritize, and execute provider performance strategies that improve quality, utilization, affordability, access to care, member outcomes, and experience
Serve as a senior clinical voice in identifying underperforming providers and developing targeted, data‑driven remediation strategies
Influence enterprise strategy through clinical insight, data interpretation, and experience working across complex provider systems
Serve as the clinical advisor to ensure strategic and contractual alignment, balancing Blue Shield of CA, Commercial clients, and provider groups’ needs with long‑term network sustainability in performance, operations, and value‑based care approaches
Represent the Commercial CMO organization in executive‑level BSC, provider, and client discussions, bringing credibility, clinical judgment, and strategic insight
Represent the Commercial CMO organization, communicate effectively with senior and executive leadership across internal and external audiences
Supervise, coach, and develop Clinical Performance Managers (CPMs), enabling them to operate with increasing independence across assigned provider groups and projects to drive provider performance and deliver on enterprise targets
Establish consistent performance management frameworks, expectations, and escalation pathways for CPM‑led provider engagements
Perform additional duties & projects assigned by Manager.