Your Role

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationship necessary to provide our members and clients with access to quality, affordable health care services. The Program Manager, Principal will report to the Director, Specialty Networks and Vendor Management. In this role, you will support Blue Shield's Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations.

Your Work

In this role, you will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals
• Consult with all levels (including senior management) making recommendations, and influencing decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement multiple and extremely complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Manage modification and negotiation of Plan to Plan vendor contracts that meets cost of health care savings strategies, provider adequacy and member service requirements, including development and oversight of corrective actions and ongoing management of process improvements
• Manage and lead development of multi-year contracting strategy, including unit cost trend targets and specific metric improvement for Plan to Plan, and Vendor contracts
• Lead the implementation of regulation and legislation that impact the behavioral heath Plan to Plan contract
• Manage project initiatives from initiation through delivery, and oversight of continuous improvement

Your Knowledge and Experience

• Typically, requires a college degree or equivalent experience. Master's degree preferred
• Requires a minimum 10 years of prior relevant experience within a managed care environment
• Requires a minimum of 5 years of healthcare compliance/legal experience
• Experience with regulatory/legislative changes
• Experience with Policy & Procedure development and auditing
• Knowledge of Behavioral Health managed care

Pay Range:

The pay range for this role is: $136,400.00 to $ 204,600.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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