Sr. Medical Director, Provider Performance
Blue Shield of CA
Your Role
The Senior Medical Director, Provider Performance, sits at the center of Blue Shield of California's efforts to elevate provider performance, clinical quality, and affordability across its entire Commercial network. The incumbent partners closely with Provider Performance, Network Management/Contracting, and internal/external partners to drive measurable provider performance improvements, while supporting key external Commercial clients. This role blends strategic influence with real execution- leading performance improvement for some of the most complex health systems while shaping network strategy, supporting contracting efforts, and delivering on the BSC mission statements.
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.
Your Knowledge and Experience
MD or DO degree required; master's degree in healthcare, public health, business, or related field preferred (MPH, MBA, MHA, etc.)
10 years of managed care experience required
5 years of clinical experience required
2 years of previous medical leadership experience required
Completed residency, preferably in adult-based primary care specialty (e.g. internal medicine, family practice)
Active, unrestricted California State Medical License
-
Demonstrated experience executing provider performance initiatives
Demonstrated ability to manage multiple complex initiatives simultaneously
Experience coordinating cross-functional, clinical, and data-oriented projects, in a matrixed environment preferred
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
$87.57k - $189.73k
...Job Title Lead Provider Relations Manager Job Summary Leads and directs team responsible... ...regarding cost control initiatives, medical cost ratio (MCR), non-emergent... ...trains, manages and evaluates team member performance - provides coaching, development, and recognition...SuggestedFull timeContract workWork experience placementWork at office$125.4k - $172.78k
...models, primary care, care for the most medically and socially complex populations, and... ...special projectsthat advance health plan performance, provider partnerships, and market growth. The... ...Internal title: Program Manager, Sr Work Mode: Mostly Remote An annual...SeniorFor contractorsWork at officeRemote work- ...Job Title Lead Medical Director Job Description Leads and manages a team of medical... ...appropriateness and medical necessity of services provided to members - ensuring members receive... ...Provides leadership and expertise in performance of prior authorization, inpatient...SeniorWork at officeLocal area
- ...Job Title Provides subject matter expertise and leadership for health plan provider relations... ...to fee-for-service (FFS) and pay-for-performance (P4P) providers. • Collaborates... ...drives timely issue resolution, electronic medical record (EMR) connectivity, and provider...SuggestedContract workWork at officeNight shift
- ...professional for a key leadership role focused on provider compensation, contracting support, and... ...someone with a strong background in medical group administration, provider... ...provider earnings, benchmarks, and plan performance • Coordinate annual reviews, reconciliations...SuggestedFull timeWork at officeMonday to Friday
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...technical application development background to understand the requirements and design of the project to engage the right resources and provide accurate estimates. SKILLS: Must have 3 -5 years of experience managing projects related to healthcare. Experience with...SeniorFull timeContract workWork experience placementLocal area- ...Your Role The Provider Network Management team consists of Provider... ...Principal will report to the Director, Provider Contracting. In... ...comprehensive management of Medical Group/IPA and Hospital provider... ...building and sustaining high-performing teams, getting results the...Full timeContract workWork at office
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$280k - $305k
...to find. We are now hiring for a Medical Director and Senior Reproductive & Integrative... ...more clinically complex patients, (2) provide supervision and clinical leadership to... ...hours/week of dedicated time) # Annual performance bonus tied to clinic-wide business...Full timeWork at officeImmediate start- ...Medical Director, Utilization Management The Medical Management team... ...Management will report to the Sr. Medical Director, Utilization... .... These functions include performance of pre-service, concurrent and... ...utilization review, and provider claims dispute reviews. In addition...Full timeWork at office
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- ...Job Description Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate...Work at officeLocal area
- ...Description Your Role The Provider Network Management team... ...Principal will report to the Director, Provider Contracting. In this... ...comprehensive management of Medical Group/IPA and Hospital provider... ...building and sustaining high-performing teams, getting results the...Full timeContract workPart timeWork at officeLocal areaWork from homeHome office2 days per week
$186.2k - $363.09k
...JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral... ...Contributes to overarching strategy to provide quality and cost-effective member care.... ...- working closely with regional medical directors to standardize behavioral health utilization...Work experience placementWork at officeLocal area$248.5k - $373k
...Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical... ...associated companies. Performance accountabilities include: Perform... ...and the sharing of program results. Provide clinical and strategic input when participating...Minimum wageWork experience placementLocal areaRemote workWork from home- ...Great Place to Work®. THE JOB Our Medical Directors (MDs) are not only exceptional... ...achievements and demonstrating appreciation for performance of the VEG Spikes, our unique,... ...passion for customer satisfaction through providing the highest medical care to patients...Full timeLocal areaFlexible hoursNight shiftWeekend work
$72.8k - $130k
...UnitedHealth Group and you'll be part of a team that's reshaping how provider networks evolve and how health care works better for millions.... ...: Manage unit cost budgets, target setting, performance reporting and associated financial models Guide development...Minimum wageFull timeContract workWork experience placementLocal area$177.5k - $256.88k
...models, primary care, care for the most medically and socially complex populations, and next... ...smooth and efficient transitions. The Director will ensure that all migration projects... ...shape the IT Strategy and lead execution, provide leadership to track and facilitate any...SeniorFor contractorsWork at office- ...capability, culture, workforce planning, and long-term business performance. This is a highly visible leadership role partnering with... ...populations, ensuring strong pipelines for critical roles. Providing strategic guidance during periods of change, including...Flexible hours
- ...Senior Level Analyst Support Provides senior level analyst support for advanced provider data management (PDM) activities including... ..., and developing and implementing solutions to optimize performance. Ensures accurate and timely maintenance of critical provider...SeniorWork at officeRemote work
$120k - $145k
...Senior HR Business Partner The SR HR Business Partner serves as a strategic and tactical... ...fill roles. Compensation Planning & Performance Management Partner with... ...Relations, Compliance & Risk Mitigation Provide hands-on guidance and support to leaders...SeniorWork at officeLocal areaFlexible hours- ...briefings) Internal Collaboration Partner with Product teams to provide feedback on SEER-MFG and SEER-H enhancements Align with... ...greater than most companies throughout the country. ~ Medical Insurance ~ Dental Insurance ~ Vision Insurance ~ Company...SeniorRemote workFlexible hours
$26 - $32 per hour
...educational team on implementation of the BIP and specific protocols and provides direct supervision to and oversight of the assigned Behavior... ...and CEUs - we will teach how to become a better leader! Medical, Dental, and Vision insurance Generous time off policy (...Hourly payRelocation packageFlexible hours- ...earning potential. Be a Contributor to Our Thought Leadership , driving both our brand and yours to greater heights. What We Provide Your success is our commitment. Our advanced infrastructure is designed to remove barriers, allowing you to dedicate your time...SeniorPermanent employmentImmediate startRemote work
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