Provider Contracting Specialist, Consultant (Behavioral Health Network Management)

Provider Contracting Specialist, Consultant

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationships necessary to provide our members and clients with access to quality, affordable healthcare services. The Provider Contracting Specialist, Consultant will report to the Manager, Specialty Networks and Vendor Management. In this role, you will support Blue Shield of California's Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations. The primary focus will be on large Behavioral Health Groups and Providers.

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.

Responsibilities

In this role, you will:

• Prepare, analyze, review, and project financial impact of large or complex provider contracts and alternate contract terms
• Conduct negotiations and draft individual contracts
• Ensure the smooth operation and administration of provider agreements
• Attain department goals under the leadership of the Director of Specialty Networks and Vendor Management, and ensure 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
• Improve and maintain highly competitive unit costs across all products and in doing so will ensure that a superior provider network is available
• Negotiate independently with minimal guidance from the manager to achieve negotiation results with the most complex providers
• Utilize strong analytical skills and tools to achieve success in negotiation results
• Meet quarterly with top providers to review claims and utilization data.

Qualifications

Your Knowledge and Experience:

• Requires a college degree in Business, Healthcare Policy, Public Health, or related field or equivalent experience
• Requires 7 years of prior relevant experience in Behavioral Health (BH) managed care and BH Provider Contracting/Negotiation, including managing complex provider negotiations
• Experience handling Letters of Agreements with behavioral health providers and telehealth groups is preferred
• Thorough knowledge of the principles of provider relations and operations of managed care commercial, Medicare, and Medi-Cal contracting
• Knowledge of behavioral health appeals and grievances

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.

About Us

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.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.