Provider Contracting Specialist, Consultant (Behavioral Health Network Management)

Your Role

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationships necessary to provide our members and clients with access to quality, affordable healthcare services. The Provider Contracting Specialist, Consultant will report to the Manager, Specialty Networks and Vendor Management. In this role, you will support Blue Shield of California's Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations. The primary focus will be on large Behavioral Health Groups and Providers.

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 Knowledge and Experience

• Requires a college degree in Business, Healthcare Policy, Public Health, or related field or equivalent experience
• Requires 7 years of prior relevant experience in Behavioral Health (BH) managed care and BH Provider Contracting/Negotiation, including managing complex provider negotiations
• Experience handling Letters of Agreements with behavioral health providers and telehealth groups is preferred
• Thorough knowledge of the principles of provider relations and operations of managed care commercial, Medicare, and Medi-Cal contracting
• Knowledge of behavioral health appeals and grievances

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.