What are the responsibilities and job description for the Provider Contracting Specialist, Consultant position at Blue Shield of California?
Job Description
Your Role
The Provider Contracting Specialist team are focused on negotiating agreements with a variety of Ancillary Provider Types including clinical laboratories, Home Infusion / Specialty Pharmacies, and Home / Durable medical Equipment providers. . The Provider Contracting Specialist, Consultants (Network Manager Ancillary and Specialty Networks) will report to the Senior Manager of Provider Contracting. In this role you will be responsible for driving strategies to reduce the Cost of Healthcare, improve quality outcomes, and broaden our networks to include Medi Cal, Medicare, and BSC Tandem / High Performing Networks Lines of Business throughout the state of California. The Contract Specialists Consultant positions also play major roles in our Network Strategy to transform reimbursement methodologies into value-based reimbursement methodologies. This Contract Specialist, Consultant position will also function as a Subject Matter Experts on the networks the positions are responsible for, supporting other Blue Shield of Ca depts such as Legal, Medical and Provider Operation, etc.
The Provider Contracting Specialist, Consultants will be members of a high performing team responsible for assigned regional service area in managing & maintaining California's largest PPO physician network, to support our 4.6 million HMO and PPO members with over $2.0 billion in annual spend.
Responsibilities
Your Work
In this role, you will :
- Attain department goals under the leadership of the Director of Provider Contracting and ensures alignment of these goals with the company's broader strategic priorities
- Continually review and modify contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches
- Lead multi-disciplinary teams including Medical Management, Provider Relations, Analytics and Sales to implement a new regional structure and help manage the total cost of healthcare within the assigned region
- Identify opportunities within the assigned local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance companies' market position
- Working closely with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets
- Helps implement department goals under the leadership of the Sr. Manager of Ancillary and Specialty Networks and ensures alignment of these goals with the company's broader strategic priorities
- Assigned SME role that requires leading the contracting team members in implementing, communicating and executing with internal and external teams.
- Improves and maintains highly competitive unit costs across all products for assigned service area and in doing so will ensure that a high performing provider network is available to all employer groups
Qualifications
Your Knowledge and Experience
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values :
Our Workplace Model :
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working :
Member-facing and approved out-of-state roles remain remote.
Physical Requirements :
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity :
External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
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