Provider Contracting Specialist, Principal -Medi-Cal

Blue Shield of California · Long Beach

Your Role

The Government Programs Team Blue Shield of California and Blue Shield of California Promise Health Plan negotiating provider contracts for commercial, Medi-Cal and Medicare lines of business for assigned providers and/or geography. In this role, you will lead complex provider negotiations and manage relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. You will help build and maintain accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and advance Promise Health Plan’s growth, quality, affordability, and member-experience objectives. Additionally, this role will be instrumental in driving strategic initiatives to support company objectives to achieve growth and maintain a strong market position and positive reputation in the market.

This role owns negotiations from strategy and financial evaluation through contract language, approval, execution, implementation, and post-contract issue resolution. The position also leads cross-functional efforts to advance affordability, network access, product strategy, and sustainable provider partnerships while protecting the company’s financial, operational, regulatory, and member interests.

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.

This person is required to be located within 50 miles of the Woodland Hills, San Diego, or Long Beach office locations.

In this role, you will lead complex provider negotiations and manage relationships with selected health systems, hospitals, medical groups, physician organizations, community providers, and ancillary providers serving Promise Health Plan members. You will help build and maintain accessible, high-quality, culturally responsive, and financially sustainable provider networks that meet regulatory requirements and advance Promise Health Plan’s growth, quality, affordability, and member-experience objectives.

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