Sr. Medical Director, Provider Performance

Senior Medical Director, Provider Performance

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 executionleading 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.

Responsibilities

In this role, you will:

• Provide strategic clinical leadership for provider performance & network strategy across all provider types, including IPAs, medical groups, hospitals, and integrated delivery systems spanning PPO, HMO, ACO, and other risk-based arrangements
• Partner closely with enterprise partners to design, prioritize, and execute provider performance strategies that improve quality, utilization, affordability, access to care, member outcomes, and experience
• Serve as a senior clinical voice in identifying underperforming providers and developing targeted, data-driven remediation strategies
• Influence enterprise strategy through clinical insight, data interpretation, and experience working across complex provider systems
• Serve as the clinical advisor to ensure strategic and contractual alignment, balancing Blue Shield of CA, Commercial clients, and provider groups' needs with long-term network sustainability in performance, operations, and value-based care approaches
• Represent the Commercial CMO organization in executive-level BSC, provider, and client discussions, bringing credibility, clinical judgment, and strategic insight
• Represent the Commercial CMO organization, communicate effectively with senior and executive leadership across internal and external audiences
• Supervise, coach, and develop Clinical Performance Managers (CPMs), enabling them to operate with increasing independence across assigned provider groups and projects to drive provider performance and deliver on enterprise targets
• Establish consistent performance management frameworks, expectations, and escalation pathways for CPM-led provider engagements
• Perform additional duties & projects assigned by Manager.

Qualifications

In this role, you will need:

• 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.

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.