Regional Manager - Provider Contracting - WDH

Transformation is the opportunity

Blue Shield of California is the third largest health plan in California, with about $7.5 billion in revenue. Our mission is to ensure Californian's access to high-quality health care at a reasonable price.

Join Blue Shield of California and grow your career with a leader that’s stirring up a change.


This position is responsible for the oversight and management of all providercontracts (medical groups/IPAs, hospitals and freestanding surgery centers)across a major California region, including ownership of one or more largeregional provider systems. Manages a team of Network Managers. Helps developunit cost trend targets and specific metric improvement for all providers withinassigned region to continously improve overall competitive position. Oversees anannual spend of approximately $2.0 Billion.

Leads cross-functional initiatives including implementation of a new regionalstrategy to help manage the total cost of healthcare across the assigned region.

Regional strategy implementation requires close collaboration with MedicalManagement, Provider Relations, Network Analytics and Sales in order to meetaggressive goals; also includes driving alignment with Pricing, Underwriting andSales regarding unit cost and other contracting activities. Identifies strategicopportunities within each local market (i.e., network expansion opportunities,utilization or unit cost excesses, etc.) and assesses market trends andcompetitive benchmarks in order to develop strategies to enhance company’smarket position.

Demonstrated leadership, program evaluation and communication skills and abilityto interact with all levels including senior management and influencedecision-making.

Has full understanding of applicable legislation/regulations and ensuresdepartmental compliance.

Bachelor's degree and seven years of relevant experience or equivalentcombination of education and experience.

Extensive knowledge of and experience in the health care industry, managed caredelivery systems, provider service network development, management andadministration; strong negotiating skills.

Demonstrated leadership, program evaluation and communication skills and abilityto interact with all levels including senior management and influencedecision-making.

Has full understanding of applicable legislation/regulations and ensuresdepartmental compliance.

Preferred experience

Minimum of a 4-year degree in Business, Healthcare Policy, Public Health orrelated field

8-10 years provider contracting experience at a senior negotiator level

6+ years of people management experience at a health plan or in a providerorganization.

Substantial experience in managing complex and high-profile providernegotiations



Demonstrated track record of change leadership including executive influencingskills

Requires broad health care strategy and overall industry knowledge

Superior technical skills in provider contracting strategy, reimbursementmethodologies and provider network analysis

Broad business skills including analysis of strategic alternatives, financialimpact analysis and sales experience/exposure

Advanced analytical skills

Excellent oral and written communication skills

Blue Shield of California is an Equal Opportunity Employer.


Our comprehensive benefits begin on your first day with medical, dental and vision coverage; 20 days PTO annually; 9 paid holidays; matching 401(k); and company pension.

Blue Shield of California is an Equal Opportunity Employer.

An Independent Member of the Blue Shield Association.

Blue Shield of California

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