Provider Contracting Specialist, Principal -Medi-Calnew

Your Role 

The Government Programs Team Blue Shield of California and Blue Shield of California Promise Health Plan negotiating provider contracts for commercial, Medi-Cal and Medicare lines of business for assigned providers and/or geography. In this role, you will lead complex provider negotiations and manage relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. You will help build and maintain accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and advance Promise Health Plan’s growth, quality, affordability, and member-experience objectives. Additionally, this role will be instrumental in driving strategic initiatives to support company objectives to achieve growth and maintain a strong market position and positive reputation in the market.

This role owns negotiations from strategy and financial evaluation through contract language, approval, execution, implementation, and post-contract issue resolution. The position also leads cross-functional efforts to advance affordability, network access, product strategy, and sustainable provider partnerships while protecting the company’s financial, operational, regulatory, and member interests.

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.

 

This person is required to be located within 50 miles of the Woodland Hills, San Diego, or Long Beach office locations.

 

Your Work 

In this role, you will: 

• Lead end-to-end negotiations and remain accountable for the timely execution of contracts with complex provider organizations across assigned providers and markets

• Own the development and execution of negotiation strategies, business cases, term sheets, and executive recommendations informed by provider, market, and competitive dynamics

• Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, and Sales to advance affordability, growth, and regional objectives

• Identify and drive network and unit-cost opportunities that strengthen market position and maintain a competitive provider network

• Support cross-functional initiatives that manage total cost of care and improve performance across assigned regions and products

• Support the investigation and resolution of complex issues by identifying root causes and implementing practical solutions

• Act with urgency and accountability to meet critical negotiation, approval, contract execution, and implementation timelines

• Perform other duties as assigned

 

Your Knowledge and Experience 

• Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree

• Requires at least 10 years provider contracting / negotiation experience including experience managing complex negotiations

• Requires 5 years working with Medi-Cal, Medicare and Commercial Lines of Business

• Requires this person to live within 50 miles of the Long Beach, San Diego, or Woodland Hills office locations

• Requires a collaborative team player approach with practical knowledge and proactive leadership and management in the execution of processes and projects within a functional team

• Requires experience working at a health plan (managed care, government payer, or academic)

• Requires technical and functional expertise, business acumen, critical thinking, and decision-making skills

• Requires exceptional written communication skills, including the ability to draft clear, concise executive summaries that articulate negotiation strategy, planning, and execution approaches

 

Hybrid

 

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

 

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.