Provider Contracting Specialist, Principal

The Provider Contracting Specialist, Principal reports to the Director, Provider Contracting and is responsible for managing contract negotiations for selected providers in Southern California. The role involves comprehensive management of Medical Group/IPA and Hospital provider networks in the assigned service areas and driving strategic initiatives to support company objectives. Responsibilities Manage contract negotiations for providers, including IPA/Medical Groups, PPO physicians, and hospitals for all products Participate in a cross‑functional team to implement initiatives to help manage the total cost of health care across the assigned region Collaborate closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals Drive alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities Identify strategic opportunities within the local market (e.g., network expansion opportunities, utilization or unit cost excesses, etc.) Assess market trends and competitive benchmarks to enhance company’s market position Support initiatives to improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all employer groups Conduct investigations using critical thinking to understand the root cause of problems and propose solutions Perform other duties as assigned Qualifications Requires a college degree in business, healthcare policy, public health or related field, or equivalent experience Requires at least 10 years provider contracting / negotiation experience including experience managing complex negotiations 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 technical and functional expertise, business acumen, critical thinking, and decision‑making skills Hybrid Virtual Work This role allows employees to work virtually full‑time; however, employees will be expected to come into the office based on business needs. 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 regard 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. #J-18808-Ljbffr Blue Shield of California