Senior Director, Network Analytics

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POST DATE 10/10/2017
END DATE 5/17/2018

Blue Shield of CA Costa Mesa, CA

Costa Mesa, CA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
17002IN-Costa Mesa
Mid-Career (2 - 15 years)
Bachelors Degree


Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of Californias Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

The Senior Director, Network Analytics is responsible for providing data and analytics to support network development, network contracting, network reimbursement, provider performance measurement and provider reporting.

The Senior Director leads a team of analysts, uses a variety of analytic tools and techniques to develop financial scenarios and reimbursement models for contract negotiation with providers. The Senior Director is a trusted adviser and a partner with the network contracting team. He/she has a good understanding of regional provider network, and works collaboratively with the Network team to develop network strategy overall, and by geography. The Senior Director develops and executes provider performance measurement strategy to support network development and provider reimbursement strategy.

Specific duties include, but not limited to:

* Oversees the creation of hospital contract negotiation material and modeling, and participates in negotiation process.

* Oversees professional fee schedule development and participates in physician group contracts negotiation.

* Oversees the development, maintenance, and reconciliation of physician risk contracts and capitated arrangement.

* Develops data and analytic strategy in conjunction with the Network Organization

* Works collaboratively with Data Services and other analytic teams in the company to execute the data and analytic strategy

* Develops provider performance measurement framework

* Produces provider performance comparison

* Delivers provider reporting for Pay for Performance program

* Manages team: hiring and training, performance and salary reviews, promotions and disciplinary matters for direct reporting employees.

* Bachelors degree in health care administration, business administration, public health, economics, statistics, computer science, finance, or a relevant field. Masters preferred.

* Minimum 5 years of experience in network analytics, experience in capitated model and California market is highly desirable.

* Minimum 3 years of experience in analyzing health care insurance claims data

* Minimum 3 years of hands-on experience in data analysis tools, including but not limited to SAS, SQL, SPSS, Access, Cognos, Tableau.

* Minimum three years of supervisory experience leading an analytics/ research team.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.