Blue Shield of California
Manager, Provider Services - Network
Blue Shield of California, California, Missouri, United States, 65018
Manager, Provider Services - Network
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Your Role The Network Performance Analysis and Contracts (NPAC) team is part of the Network Management and Provider Partnerships department and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield of California (BSC) and Promise Health Plan’s (PHP) network of physicians, hospitals, ambulatory surgery centers, HMO IPAs, and medical groups. As the Manager, Provider Services – Network, you will lead a dedicated team to ensure the accurate and timely completion of all provider network regulatory filings for CMS, DMHC, DHCS, and CDI. Reporting to the Director, Provider Services – Network, your role will involve supporting ad hoc strategic evaluations, reporting, and filings as needed. Additionally, you will play a critical role in driving alignment and providing recommendations to leadership regarding the team's work, contributing to the overall success and compliance of the organization.
Responsibilities
Lead the team to achieve the required tasks, ensuring all outputs meet the high expectations of both internal and external clients.
Support the success of the company's key strategic initiatives by ensuring the approval and expansion of provider networks with regulatory agencies (DMHC, CDI, DHCS, CMS). This is critical for the company's strategy to sell and grow in specific markets and products.
Fulfill regulatory requirements and filings, including Access and Availability, DMHC (TAR, 10% change), DHCS required filings, and Covered CA, to ensure continued marketing and sales of existing provider networks.
Assist the Director and collaborate with business partners to create a strategic vision involving analytical tools, process improvements, and product/service offerings.
Work with the team to execute the strategic vision through milestones, deliverables, and performance measurement. Identify and manage risks associated with the strategic vision.
Develop and implement short-term and long-term strategies to improve team results and meet company goals.
Lead the team to ensure all provider network regulatory filings for CMS, DMHC, DHCS, and CDI are completed accurately and on time.
Support ad hoc strategic evaluations, reporting, and filings as needed.
Collaborate with key stakeholders to manage end-to-end processes impacting provider network regulatory filings and reporting, ensuring high-quality output.
Develop and present metrics and dashboards during committee meetings.
Assist the team in identifying and implementing process improvements to support ongoing changes in the regulatory environment and requirements.
Qualifications
Requires a college degree or equivalent experience.
Requires 7 years of prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager.
Project management experience.
Strong knowledge of provider networks and healthcare system.
Strong interpersonal skills, ability to work effectively and build relationships with subordinates, peers, senior-level staff, cross-functional teams.
Ability to lead and influence cross-functional teams, including teams with senior-level leadership involvement or oversight.
Strong analytical, problem-solving, and critical thinking skills.
Ability to navigate ambiguous problems and break down complex issues into manageable chunks for structured problem-solving.
Ability to influence and drive decision making among all levels of stakeholders.
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.
We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
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.
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Get AI-powered advice on this job and more exclusive features.
Your Role The Network Performance Analysis and Contracts (NPAC) team is part of the Network Management and Provider Partnerships department and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield of California (BSC) and Promise Health Plan’s (PHP) network of physicians, hospitals, ambulatory surgery centers, HMO IPAs, and medical groups. As the Manager, Provider Services – Network, you will lead a dedicated team to ensure the accurate and timely completion of all provider network regulatory filings for CMS, DMHC, DHCS, and CDI. Reporting to the Director, Provider Services – Network, your role will involve supporting ad hoc strategic evaluations, reporting, and filings as needed. Additionally, you will play a critical role in driving alignment and providing recommendations to leadership regarding the team's work, contributing to the overall success and compliance of the organization.
Responsibilities
Lead the team to achieve the required tasks, ensuring all outputs meet the high expectations of both internal and external clients.
Support the success of the company's key strategic initiatives by ensuring the approval and expansion of provider networks with regulatory agencies (DMHC, CDI, DHCS, CMS). This is critical for the company's strategy to sell and grow in specific markets and products.
Fulfill regulatory requirements and filings, including Access and Availability, DMHC (TAR, 10% change), DHCS required filings, and Covered CA, to ensure continued marketing and sales of existing provider networks.
Assist the Director and collaborate with business partners to create a strategic vision involving analytical tools, process improvements, and product/service offerings.
Work with the team to execute the strategic vision through milestones, deliverables, and performance measurement. Identify and manage risks associated with the strategic vision.
Develop and implement short-term and long-term strategies to improve team results and meet company goals.
Lead the team to ensure all provider network regulatory filings for CMS, DMHC, DHCS, and CDI are completed accurately and on time.
Support ad hoc strategic evaluations, reporting, and filings as needed.
Collaborate with key stakeholders to manage end-to-end processes impacting provider network regulatory filings and reporting, ensuring high-quality output.
Develop and present metrics and dashboards during committee meetings.
Assist the team in identifying and implementing process improvements to support ongoing changes in the regulatory environment and requirements.
Qualifications
Requires a college degree or equivalent experience.
Requires 7 years of prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager.
Project management experience.
Strong knowledge of provider networks and healthcare system.
Strong interpersonal skills, ability to work effectively and build relationships with subordinates, peers, senior-level staff, cross-functional teams.
Ability to lead and influence cross-functional teams, including teams with senior-level leadership involvement or oversight.
Strong analytical, problem-solving, and critical thinking skills.
Ability to navigate ambiguous problems and break down complex issues into manageable chunks for structured problem-solving.
Ability to influence and drive decision making among all levels of stakeholders.
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.
We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
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.
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