Your Work 

In this role, you will: 

• Develop comprehensive contracting strategy for ancillary services that drives CoHC savings. This may include developing strategic partnerships, targeted narrowing or expansion of the network for certain services and geographies, and payment structure changes.
• Lead ancillary network management activity for commodity services including lab, infusion, and durable medical equipment, and other ancillary services as assigned.  This includes negotiating contracts, managing the network of providers, ensuring compliance, and monitoring performance to control costs and support high-quality care.
• Develop contracting strategy for Skilled Nursing Facilities to improve access and enable faster transition of members from inpatient acute to step-down care. Lead Skilled Nursing facility contracting team to negotiate and execute contracts, manage the provider network, and monitor provider performance.
• Ideate and evaluate innovative care delivery solutions in collaboration with Partner Services, Product and HQA leadership and vendors.
• Own ancillary network remediation activities- negotiating contracts, managing the network of providers, ensuring compliance, and monitoring performance to control costs and support high-quality care.
• Support broader network negotiations and other network management department objectives as needed
• Contribute to HQA AI strategy and make recommendations on area of potential implementation. 
• Forecast ROI benefits
• Lead and mentor a team of healthcare professionals. Foster a culture of excellence and continuous improvement. Collaborate with affordability office, finance, clinical, and operational teams to ensure strategic alignment to attain BSC financial targets.

Your Knowledge and Experience 

• Requires a Bachelor’s degree or equivalent experience
• MPH, MBA, or MHA is preferred
• Requires 12 years of provider contracting experience, preferably within a managed care organization with a focus on healthcare quality and affordability and health plan operations.
• Requires 8+ years of direct experience leading and managing staff.
• Proven track record of developing and implementing successful strategies that drive cost savings and improve healthcare value.
• Capacity to lead and inspire cross-functional teams to achieve high-performance results.
• Exceptional skills in both written and verbal communication and extensive executive communication experience
• Strong analytical skills and experience leveraging data to inform strategy and measure performance.
• Ability to address and resolve complex operational challenges effectively.
• Ability to navigate and adapt to a rapidly changing healthcare landscape.

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.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!  

Our Values: 

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. 
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

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.