Job Description

Your Role

The Corporate Actuarial and Provider Strategies team oversees all things related to cost of healthcare for the Actuarial organization, including Reserves, Trend Forecasting, Pay for Value models, and Provider Contract Analysis. The Senior Director of Network Contract Trend Analytics will report to the Vice President of Corporate Actuarial and Provider Strategies. In this role you will lead multiple analytic teams that are responsible for the financial modeling of provider contracts (professional, facility, and capitation). You will be a crucial partner for the Network team for provider contracting strategy, optimization, and negotiation. You will lead the annual provider budget process and ensure it is consistent with and connected to Blue Shield\xe2\x80\x99s overall strategic short term and long term goals.

Your Work

In this role, you will:

• Manage business unit planning and strategies that support the development and execution of Plan, long-term strategies and incentive metrics
• Ensure timely tracking of results and course correction activities as needed
• Responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations
• Develop and lead a comprehensive unit cost budget process, which includes seeking alignment with key stakeholders across the Enterprise
• Work with contracting team in real time during negotiations on potential scenarios and strategies
• Collaborate with Network and Pricing teams on non-standard contract negotiations and strategies (e.g. Exchange networks, DRG conversion, termination analyses)
• Create and deploy an analytic strategy that leverages Federal Transparency data to optimize provider contracts and support Self Funded sales efforts
• Coordinate overall network strategy, inclusive of how we combine traditional contracting work with our longer term Pay for Value strategies

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We\'re excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area\'s top companies in volunteering & giving, and one of the world\'s most ethical companies. Here at Blue Shield of California, we\'re striving to make a positive change across our industry and the communities we live in , Join us!

Blue Shield of California