Job Abstract

Your Role

The Provider Partnerships & Network Management team is responsible for managing California’s largest PPO Physician Network to support our members in achieving access to high quality care at an affordable price. The Sr. Manager, Provider Contracting will report to the Director, PPO Professional, Specialty & Ancillary Networks. In this role you will lead a high performing team to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. 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:

• Help develop unit cost trend targets and specific metric improvement for all providers within the assigned region to constantly improve overall competitive position
• Participate in or lead cross functional teams to implement initiatives to help manage the total cost of health care across the assigned region and manage larger strategic initiatives across regions or statewide
• Work closely with the contracting team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets
• Continually review and modify contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities
• Improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all employer groups
• Provide strong and focused leadership to the negotiating team directly accountable for achieving department metrics
• Helps implement department goals under the leadership of the Contracting Executives and ensures alignment of these goals with the company's broader strategic priorities
• Continually review and modify contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities
• Track and trend data and identify potential contracting or service-improvement opportunities.
• Responsible for adjusting or recommending system enhancements and process improvements to solve problems or improve effectiveness of job area.