Director, Provider Services - Relations

Your Role

Reporting to the VP, Network Operations, the Director, Provider Services - Relations, Blue Shield of California and Promise Health Plan (BSCPHP), is responsible for creating and maintaining high integrity relationships with risk‑baring medical providers, hospitals and health systems in their assigned region to enable BSCPHP to become the health plan of choice. The outcome of being the ideal partner for our providers will be to materially improve cost, quality, maintain compliance, service and together grow membership in service to our communities across BSCPHP business.

The Director will lead in a highly matrixed environment across multiple internal business teams to provide strategic alignment, business planning, and effective execution of the business plans for all providers in their region for BSCPHP business as well as partner with all lines of business as they impact our Provider Network.

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.

• Requires a college degree or equivalent experience. Master’s degree is preferred
• Requires 10 years prior relevant experience in Provider Relations or healthcare network contracting
• Requires 6 years of management experience and must be comfortable operating in a matrixed/collaborative environment
• Minimum 5 years of direct Medicare and Medi‑Cal experience with a Managed Care Organization (MCO) preferred
• Previous experience in management of process analysis and improvement
• Experience in the development of policies and procedures pertaining to Network Management
• Strong experience and orientation to the quadruple aim coupled with knowledge of markets, sales, operations, product development, network management, clinical operations, finance, regulatory issues and compliance
• Able to collaborate and work strategically in a team setting with various professional, technical, and administrative staff, integrating resources in a timely and organized manner
• Comprehensive knowledge of managed care risk contracts and the operational requirements involved in managing a provider network
• Outstanding verbal and written communication abilities, with demonstrated effectiveness when engaging executive leadership
• Demonstrated ability to build enduring, trustworthy relationships and effectively interact across all organizational levels, both internally and externally
• Ability to lead and manage significant culture change. Demonstrated experience with change and organization management; possess a performance driven management style
• Strong leadership skills, including excellent interpersonal, communications, problem solving and negotiating skills
• Ability to think strategically while at the same time drive operational performance
• Proven project management experience applying industry methodologies and practices
• Technologically savvy and able to utilize information systems and Office software effectively
• Proven ability to mentor and coach leaders in their respective teams