Full-Time
Senior Manager
Network Operations
Posted on 10/1/2025
Blue Shield of California
5,001-10,000 employees
California nonprofit health insurance provider
No salary listed
Long Beach, CA, USA + 6 more
More locations: Rancho Cordova, CA, USA | Galt, CA, USA | Canoga Park, Los Angeles, CA, USA | Oakland, CA, USA | El Dorado Hills, CA, USA | San Diego, CA, USA
In Person
 Business & Strategy (2) |
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- Bachelor’s degree in business administration, Healthcare Administration, or a related field is required
- Minimum of ten years of relevant experience in health plan strategy, managed care operations, or provider contracting, including at least four years in management or matrixed management roles
- Previous experience in extensive healthcare program or project management
- Outstanding verbal and written communication abilities, with demonstrated effectiveness when engaging executive leadership
- Comprehensive knowledge of managed care risk contracts and the operational requirements involved in managing a provider network
- Proven capability to manage a portfolio; prioritizing multiple tasks and objectives simultaneously
- Skilled in handling highly confidential information and serving as a liaison between business leaders and various internal and external stakeholders
- Demonstrated ability to build enduring, trustworthy relationships and effectively interact across all organizational levels, both internally and externally
- Capable of influencing higher-level management decisions related to large-scale tactical adjustments to organizational enhancements
- Able to collaborate and work strategically in a team setting with various professional, technical, and administrative staff, integrating resources in a timely and organized manner
- Lead the Network Transition team in overseeing the monitoring of provider renewals and potential termination process for all lines of business, including risk-bearing medical groups/IPAs, hospitals, integrated health systems, and PPO individual providers
- Collaborate cross-departmentally to develop and maintain documented policies and procedures related to provider renewals and terminations
- Drive ongoing process improvement by performing gap analyses, evaluating lessons learned, and integrating stakeholder feedback
- Develop and manage consistent inter-departmental and multi-level communication channels to support organizational alignment and engagement
- Conduct and organize internal operations meetings with stakeholders and leadership to support coordination, accountability and timely completion of work associated with renewals and terminations
- Analyze complex data sets to deliver actionable insights that support strategic decision-making within Network Operations
- Evaluate the operational effects of negotiations and formulate suitable mitigation strategies
- Coordinate with the Network Management Contracting team to execute and communicate internal operational strategies related to contract renewals
- Identify and prioritize project risks, escalating significant issues to leadership with recommended actions and appropriate urgency to enable timely decisions
- Oversee the expanded scope of the Network Transition Team as evolving requirements affect multiple types of providers and lines of business
- Work collaboratively with internal stakeholders to ensure teams are equipped with necessary resources to maintain regulatory compliance, enhance member experience, and uphold network integrity
- Support the establishment of governance frameworks to strengthen accountability, transparency, and effective decision-making throughout network operations
- Sets operational objectives for the Network Transition team and collaborates with other managers to define group objectives
- Contribute to the design and execution of strategic initiatives that enhance the provider network’s influence on member experience, while ensuring alignment with overarching healthcare quality and affordability objectives
- Promote a collaborative and partnership-oriented culture by nurturing strong relationships with internal stakeholders to achieve collective success
Blue Shield of California is a nonprofit health plan provider that offers medical insurance options for individuals, families, and employers within California. It operates as a mutual benefit corporation and maintains a broad network of healthcare professionals and facilities, enabling members to access care and manage claims through an online portal. Its services include preventive care programs and digital health coaching, with prior authorization required for certain medical, surgical, and some prescription drugs to control costs and ensure medical necessity. The company draws a substantial portion of its membership from CalPERS and focuses on delivering stable, affordable access to care within the state. Its goal is to provide members with reliable health coverage, a wide provider network, and tools to manage their health and expenses efficiently.
Company Size
5,001-10,000
Company Stage
N/A
Total Funding
N/A
Headquarters
null
Founded
1939
Simplify's Take
What believers are saying
- CJ Bhalla from Kaiser oversees $27B revenue as CFO since May 18.
- Kevin Jacobsen, ex-Clorox CFO, joins board for financial transformation.
- Senate Bill 153 mandates training by 2029, expanding BlueSky partnerships.
What critics are saying
- Frequent CEO turnover erodes execution after Quam exit in March 2025.
- CalPERS contract scrutiny triggers member exodus over premium hikes.
- DMHC audits prior authorizations impose multimillion fines in 12 months.
What makes Blue Shield of California unique
- Blue Shield commits to 42% direct emissions cut by 2030, validated by SBTi.
- BlueSky initiative trains 9,000 educators in Youth Mental Health First Aid.
- Pharmacy Care Reimagined led by Hayley Park reduces drug costs statewide.
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Benefits
Mental Health Support
Company News
Blue Shield of California and California Department of Education offer Youth Mental Health First Aid training to California teachers. Free online training, available in English and Spanish, has already helped more than 9,000 educators and caring adults support youth behavioral health. March 25, 2026 The California Department of Education has joined with Blue Shield of California to offer free Youth Mental Health First Aid training from the National Council of Mental Wellbeing. The eight-hour English and Spanish trainings run through June and equip adults to recognize signs of mental health or substance use challenges in youth, respond in both crisis and non-crisis situations, and connect students to appropriate professional support. Participants learn how to start difficult conversations, assess risk and create action plans. The program is designed for adults working with youth ages 6-18 in California schools, including administrators, teachers and staff. Today, California's 5.8 million K-12 students are navigating an escalating mental health crisis, driven by the pandemic, economic strain and social media. In Blue Shield's recent BlueSky Youth Mental Health Survey, 94% of Gen Z youth reported regular mental health challenges - a generation in distress. The good news: Blue Shield can do something about it. To address this, California now requires all public school staff to complete evidence-informed youth behavioral health training, identified by the California Department of Education as Youth Mental Health First Aid (YMHFA). By July 1, 2029, all local education agencies must certify that 100% of certified employees and 40% of classified staff with direct contact in grades 7-12 have completed training. Blue Shield has supported this work since 2021 through its BlueSky Youth Mental Health Initiative, and has directly supported Youth Mental Health First Aid training for 9,071 educators, school administrators, parents and other caring adults statewide. Paula Ambrose, Blue Shield of California "When a child needs CPR at school, we expect a teacher to act until emergency help arrives," said Paula Ambrose, who leads Blue Shield's BlueSky Youth Mental Health Initiative. "Mental health crises deserve the same urgency. Youth Mental Health First Aid empowers educators to support students in distress and serve as a bridge to ongoing, holistic care." Often, the first person a student turns to isn't a therapist. It's a trusted teacher, coach or mentor. Many training participants report immediate impact: 94% of respondents reported feeling confident assisting a young person in emotional distress, including with suicidal ideation or substance abuse challenges, and many educators have used the training to intervene in real-time crises, according to an evaluation survey from the University of California San Francisco, based in the Philip R. Lee Institute for Health Policy Studies. One educator shared in an evaluation survey: "The morning after the program, one of my students was teary and asked to step outside. As we were trained, I asked if she was thinking about suicide. I was shocked when she said yes. I connected her with the school counselor immediately. She seemed to have everything going for her, but she had been hiding her feelings behind a happy face. Now she's getting the support she needs." According to Karrie Sequeira, director at the California Department of Education, statewide implementation is a major step forward, as the mental wellness of its school communities is a priority. However, because it is currently an unfunded mandate, school districts must identify the necessary resources to implement youth mental health training, as required by Senate Bill 153. Blue Shield's early, multi-year investment has helped jump-start this effort, establishing credibility and attracting additional partners. "In alignment with SB 153, to train 100% of certificated staff and 40% of classified staff, it will require significant resources," said Sequeira. "Blue Shield's partnership in prioritizing the mental wellness of our school communities, by providing seed funding, has been instrumental in establishing a strong foundation, ensuring ongoing support, and positioning us to pursue additional resources to extend and expand our offerings - and we now have data demonstrating the impact on those receiving the training." Strengthening this first line of defense helps identify youth depression earlier, address anxiety, intervene in substance use and reduce suicide risk - ensuring more young people receive help before their struggles escalate. "There can be a ripple effect," said Ambrose. "Over time, trained educators may support many students, some of whom are facing real challenges. Even small moments of understanding and early support can make a difference, helping young people feel seen and get connected to the care they need and deserve." To learn more about upcoming trainings or schedule a future training, visit the California Department of Education, follow on Facebook, Instagram, or X, or email [email protected]. Space is limited to 30 participants per session. * BlueSky: Blue Shield of California's BlueSky youth mental health initiative is a multi-year effort to promote emotional well-being for young people across California. Since 2019, BlueSky has supported over 25,000 youth and educators through on-campus and online mental health services, educator training and youth-driven advocacy programs. * Blue Shield members: Blue Shield mental health & substance use resources * BlueSky partners: Its BlueSky youth mental health partners include the Climate Mental Health Network, Directing Change, Mental Health California's Brother Be Well and "Into the Classroom," and Wellness Together and their Wellness Education Lab.
Image: Blue Shield of California_Kevin Jacobsen Jacobsen joins Blue Shield of California board. Blue Shield of California appoints Kevin Jacobsen, former chief financial officer (CFO) of The Clorox Company, to its board of directors. Jacobsen brings more than 30 years of financial and operational leadership experience to the nonprofit health plan. During his seven-year tenure as CFO at Clorox, he managed financial reporting and controls, enterprise risk management, tax, treasury, internal audit, and mergers and acquisitions. A qualified financial expert, Jacobsen served as chair of the board of the Clorox Captive Insurance Company between 2021 and 2025. Pamela DeCoste, board chair for Blue Shield of California, says: "Kevin is a deeply respected financial leader with firsthand experience guiding organisations through major operational and digital transformation. His ability to navigate complexity while keeping a long-term view will be invaluable to Blue Shield of California as we continue to modernise healthcare delivery and further strengthen our goal to create a healthcare system that's worthy of our family and friends and sustainably affordable." Commenting on his appointment, Jacobsen says: "Blue Shield's mission and values resonate deeply with me, particularly its commitment to affordability, transparency and improving the healthcare system for all Californians. I'm honoured to join the Blue Shield of California Board of Directors, and I look forward to contributing my experience to support the nonprofit health plan's mission to provide access to quality health care that's sustainably affordable for everyone." Jacobsen holds an MBA from the University of Rochester and a finance degree from the University of California, Riverside. He also completed the Wharton Executive Education Program.
Leading the Way: celebrating San Diego health leaders. Blue Shield Promise honors individuals and organizations for outstanding contributions and providing high-quality, compassionate care in San Diego County. SAN DIEGO, Calif. (Nov. 13, 2025) - Blue Shield of California Promise Health Plan will recognize more than 30 individuals and organizations for their outstanding work in meeting the full range of health needs of residents in San Diego County at the nonprofit health plan's third annual Leading the Way Awards Dinner at The Prado in Balboa Park on Thursday, Nov. 13, 2025. The honorees are a wide-ranging group of individuals and organizations who are helping improve health access, increase health equity and ensure San Diegans receive high-quality care. "Our Leading the Way Award winners are champions of care and innovation," said Kristen Cerf, president and CEO of Blue Shield Promise. "Their dedication ensures Medi-Cal members and San Diego County residents receive the high-quality services that help them live active, healthy lives. They truly make a difference in our community." This year, the Leading the Way Awards will be given in categories including Distinguished Service, Wellness & Empowerment, Youth Engagement & Resiliency, Equitable Health Access and Quality Health Care. The Visionary Awards - the plan's highest honors - will go to SBCS (formerly South Bay Community Services) of Chula Vista and Fernando Sañudo, chief executive officer of Vista Community Clinic. Both have exemplified extraordinary commitment to the needs of San Diego County residents for more than a half century. "SBCS is deeply honored to receive this award from Blue Shield Promise. It's a powerful affirmation of our unwavering commitment to meet the urgent needs of our community with heart, speed and purpose," said Kathryn Lembo, chief executive officer of SBCS. "Every step we take is guided by compassion and accountability - not just to our funders, but to every individual and family we serve. We believe in creating lasting change, and we're proud to help our communities grow stronger, more resilient and more hopeful every day." "The success of Vista Community Clinic has never been about one person - it's been about the collective strength of a team united by a deep commitment to access, equity and community," Sañudo said. "Together, we've built more than an organization. We've cultivated a culture rooted in compassion, excellence and opportunity. None of this happens in isolation - it takes vision, unwavering persistence and powerful partnerships. Community health centers are not just clinics; they are engines of hope, resilience and equity that work every day to transform lives and uplift entire communities. Thank you, Blue Shield Promise for this incredible honor." "Our mission is critical, and we cannot achieve it alone," Cerf said. "Partnering with dedicated local leaders like Fernando Sañudo and organizations such as SBCS - alongside many others committed to improving health care in San Diego - is a true privilege. This award is just a small token of the recognition they all deserve." Blue Shield Promise Health Plan Leading the Way 2025 Honorees Leading the Way Visionary Award * SBCS - Strengthening Communities * Fernando Sañudo, CEO, Vista Community Clinic Leading the Way for Distinguished Service - Individual Award * Blanca Fresno, MD * Chris Gordon, MD, MBA * Mumtaz Almansour, MD * Francisco Recalde, MD * Gina Rosenfeld, MD, FAAP * Joe Sepulveda, MD, ABPN, ABPM, FAPA, FASAM Leading the Way for Distinguished Service - Group Award * Family Health Centers of San Diego for Outreach to Homeless Populations * La Maestra Community Health Centers for Outreach to Justice Involved Populations * San Diego American Indian Health Center for Youth Outreach and Teen Center * San Ysidro Health for Outreach to Communities Impacted by the San Diego Wildfires * TrueCare for Outreach to Communities Impacted by the San Diego Wildfires * Vista Community Clinic for Outreach to Migrant Populations Leading the Way for Equitable Health Access * Catholic Charities Diocese of San Diego * Deaf Community Services * Episcopal Community Services * San Diego Regional Center * Serving Seniors Leading the Way for Wellness & Empowerment * Humanity Showers * Sharia's Closet * Third Avenue Charitable Organization (TACO) * Think Dignity * Voices of Its City Leading the Way for Youth Engagement and Resiliency * Barrio Logan College Institute * Community Wraparound * North County LGBTQ Resource Center * San Diego Youth Services * Teens Rise Foundation * transcenDANCE Youth Arts Project * Youth Empowerments Finest Leading the Way for Quality Health Care * Family Health Centers of San Diego, Highest Quality Performance (Large Size Group) * Vista Community Clinic - A Member of Integrated Health Partners of Southern California, Highest Quality Performance (Medium Size Group) and Largest Percentage of Measures Reaching the 90th Percentile * San Diego Family Care - A Member of Integrated Health Partners of Southern California, Highest Quality Performance (Small Size Group) and Tied for the Largest Percentage of Measures Reaching the 75th Percentile * Neighborhood Healthcare - A Member of Integrated Health Partners of Southern California, Tied for the Largest Percentage of Measures Reaching the 75th Percentile * La Maestra Community Health Centers, Most Improved in the Percentage of Measures at or above the 50th Percentile About Blue Shield of California Promise Health Plan Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering the Managed Medi-Cal program. It is led by healthcare professionals with a "members-first" philosophy and is committed to supporting a quality network of providers and partnering with community organizations. Blue Shield serve about 580,000 members across Los Angeles and San Diego counties. It was also rated 4 out of 5 in NCQA's Medicaid Health Plan Ratings 2024. For more information about Blue Shield of California Promise Health Plan, please visit www.blueshieldca.com/promise. For more news about Blue Shield of California Promise Health Plan, please visit promisenews.blueshieldca.com. Or follow Blue Shield on LinkedIn.
Blue Shield of California earns top score on the 2025 Disability index - PR newswire. OAKLAND, Calif., Oct. 14, 2025 /PRNewswire/ - Blue Shield of California has been named a "Best Place to Work for Disability Inclusion" on the... Based on recent headline ratings, 89% of this readership currently trusts the local media, which has an average score of 89% regionally and is currently trending negative. Media Trust Score
Earlier this year, Blue Shield announced Blue Shield received a 4 out of 5 in the National Committee for Quality Assurance (NCQA) Medicaid Health Plan Ratings 2024, earning high scores in key areas including disease prevention, overall care and member satisfaction.