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.

Responsibilities

Your Work 

In this role, you will: 

• Lead end-to-end negotiations and remain accountable for the timely execution of contracts with complex provider organizations across assigned providers and markets

• Own the development and execution of negotiation strategies, business cases, term sheets, and executive recommendations informed by provider, market, and competitive dynamics

• Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, and Sales to advance affordability, growth, and regional objectives

• Identify and drive network and unit-cost opportunities that strengthen market position and maintain a competitive provider network

• Support cross-functional initiatives that manage total cost of care and improve performance across assigned regions and products

• Support the investigation and resolution of complex issues by identifying root causes and implementing practical solutions

• Act with urgency and accountability to meet critical negotiation, approval, contract execution, and implementation timelines

• Perform other duties as assigned

Qualifications

Your Knowledge and Experience 

• Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree

• Requires at least 10 years provider contracting / negotiation experience including experience managing complex negotiations

• Requires 5 years working with Medi-Cal, Medicare and Commercial Lines of Business

• Requires this person to live within 50 miles of the Long Beach, San Diego, or Woodland Hills office locations

• 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 experience working at a health plan (managed care, government payer, or academic)

• Requires technical and functional expertise, business acumen, critical thinking, and decision-making skills

• Requires exceptional written communication skills, including the ability to draft clear, concise executive summaries that articulate negotiation strategy, planning, and execution approaches

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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. 

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.