VP, Provider Network Management - South

Your Role

Reporting to the SVP of Provider Partnerships and Network Management, the role of the VP, Provider Network Management: Southern CA, Medi-Cal & Behavioral Health contributes to Blue Shield's overall strategy and goals by providing leadership to a team of 50 for Provider Contracting and ensures interconnected performance with other teams and divisions. This is the central role responsible for the oversight and execution of our provider contracting roadmap and provider related strategies to support BSC growth, quality and affordability goals for BSC health plan products. The VP, Provider Network Management: Southern CA and Medi-Cal is critical to the success of Blue Shield of California and the Network Management department in realizing its goals and objectives. This individual will play a key role as part of Network Management team in delivering and collaborating on all aspects of network design and provider contracting.

In this highly visible role, the VP is also responsible for developing and maintaining excellent relationships with leaders from Blue Shield's provider partners, regulators and industry collaborators. Additionally, the VP is responsible for providing strategic and operational leadership in executing our provider network strategy with hospitals, medical groups, IPAs, ASCs, SNF’s, and health systems. The VP is also responsible for collaboratively enhancing Blue Shield's contracting capabilities through the development of strong relationships within Strategy and Health Solutions, and being interconnected with teams including actuary, finance, medical informatics, product, and markets/sales/account teams.

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 Work

In this role, you will:

• Provider contracting for medical services for Southern California.
  Provider contracting for Medi-Cal network in San Diego and LA counties, and in counties targeted for Medi-Cal product expansion statewide.
• Execute on cost of healthcare initiatives and help achieve cost of healthcare unit cost goals.
  Improve network access and availability and meet network access requirements by various regulatory agencies.
• Provide strategic leadership and mentoring to the Contracting, building a high-performing team that meets all operating goals, including cost of health care, regulatory, compliance, administrative costs and employee engagement.
• Manage increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.
• Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the enterprise strategy.
• Continuous partners with providers to influence and improve provider performance around access and availability, quality and affordability.
• Instill a culture of continuous process improvement and innovation.
• Initiate, nurture and maintain effective channels of communication with matrix partners including but not limited to Actuary, Finance, Quality, Product, and Markets/Sales/Account teams.
• Manage strategic positioning for provider contracting, develop networks and identify and act upon opportunities for greater value-orientation and risk arrangements.
• Continuously track the managed care environments to identify and implement innovative approaches to improving upon value-based reimbursement methods.
• Support the scaling of Health Reimagined solutions via inclusion in applicable provider contracts
• Administrative budget planning, forecasting and tracking.

Your Knowledge and Experience

• Minimum of 12 years of Network Management (or prior relevant experience) experience required, including 8 years of management experience.
• Bachelor’s degree or equivalent experience required; emphasis on health administration, business administration or public health preferred.
• Experience providing leadership to large teams required; experience leading senior people leaders preferred.
• Experience driving provider contracting in a network model required.
• Broad and deep health care strategy and overall industry knowledge, and understanding of the California health care landscape.
• Team player with proven ability to work cross-functionally and develop strong collaborative working relationships within a fast-paced, matrix organization.
• Demonstrated ability to build high-performing teams, and lead and manage organizations through significant change.
• Ability to think strategically and act tactically.
• The ability to influence both sales and provider audiences through strong written and verbal communication skills.
• Excellent presentation skills.
• Demonstrates managerial courage and change leadership in a dynamic environment.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Technologically savvy and able to utilize information systems effectively.

ABOUT THE TEAM
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:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o 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.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

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.

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.