Hybrid Network Compliance Manager - Health Plan Regulation

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 120,000 - 190,000; Full time

Job summary

Blue Shield of California in Rancho Cordova is seeking a Network Compliance Manager, Principal, reporting to the Sr. Manager of Network Operations.

You will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing compliance across Commercial, Medicare Advantage, and Medi-Cal lines. You will lead regulatory initiatives including block transfers, provider termination transition planning, member notification processes, and

Qualifications

• Bachelor's degree or equivalent with 4 years of experience in lieu of degree.
• At least 10 years of relevant experience in health plan compliance.
• 5+ years of progressive compliance experience in health plans.
• DMHC and block transfer experience strongly preferred.
• Strong interpersonal and written/verbal communication skills.
• Ability to work independently under limited supervision.
• Advanced proficiency with MS Office (Word, PowerPoint, Excel).
• CHC or related credential preferred.

Responsibilities

• Collaborate with the Network Compliance team on regulatory matters.
• Serve as liaison with state regulators and plan partners to maintain strong relationships.
• Oversee compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal.
• Lead regulatory initiatives such as block transfers and provider termination planning.
• Manage member notification processes and required state filings.

Skills

Interpersonal communication

Verbal and written communication

Independent working

Detail oriented

MS Office proficiency

Education

Bachelor's degree or High School Diploma/GED with 4 years related experience

10 years of prior relevant experience

5+ years health plan compliance experience

CHC designation or related credential preferred

Job description

Blue Shield of California in Rancho Cordova is seeking a Network Compliance Manager, Principal, reporting to the Sr. Manager of Network Operations.

You will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing compliance across Commercial, Medicare Advantage, and Medi-Cal lines. You will lead regulatory initiatives including block transfers, provider termination transition planning, member notification processes, and