Provider Contracting Specialist, Consultant (Behavioral Health Network Management)

About the 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 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 and support Blue Shield of California’s Behavioral Health and selective Ancillary programs, including Plan to Plan and vendor operations. The primary focus will be on large Behavioral Health Groups and Providers.

Our leadership model emphasizes developing great leaders at all levels, creating growth opportunities—personally, professionally, and financially—and fostering an environment where creative and critical thinking, high-performing teams, ethical results, and continuous learning thrive.

Responsibilities

• Prepare, analyze, review, and project financial impact of large or complex provider contracts and alternate contract terms.
• Conduct negotiations and draft individual contracts.
• Ensure the smooth operation and administration of provider agreements.
• Attain department goals under the leadership of the Director of Specialty Networks and Vendor Management, aligning these goals with the company’s broader strategic priorities.
• Continually review and modify contracting and cost of healthcare savings strategies in response to shifts in provider and competitor negotiating approaches.
• Improve and maintain highly competitive unit costs across all products to ensure a superior provider network is available.
• Negotiate independently with minimal guidance from the manager to achieve results with the most complex providers.
• Utilize strong analytical skills and tools to succeed in negotiation outcomes.
• Meet quarterly with top providers to review claims and utilization data.

Requirements

• College degree in Business, Healthcare Policy, Public Health, or related field, or equivalent experience.
• Seven 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.

Schedule

This role follows a hybrid workplace model, requiring in-office presence two days each week for most teams. Employees located more than 50 miles from an office, out-of-state employees, and those in certain member-facing roles should work with their manager to determine in-office time based on business needs.

Pay

• California: $111,540.00 to $167,420.00
• Bay Area: $125,736.00 to $188,728.00

Note: This range represents the pay range for this and many other positions at Blue Shield within this pay grade. Salaries are based on candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun, a nonprofit corporate entity that includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations form the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends—sustainably affordable, transforming healthcare by lowering costs, improving quality, and enhancing the member and physician experience. We foster a supportive workplace that upholds our values and advances our goals, recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also recognized by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the United States.

Our Values

• Honest: We hold ourselves to the highest ethical and integrity standards, building trust by doing what we say and acknowledging and correcting where we fall short.
• Human: We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous: We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Physical Requirements

Office Environment – roles involving part- to full-time schedule in an office setting. Based in physical offices and work-from-home deskwork. Activity level: Sedentary, frequency most of the workday.