Network Compliance Leader — Medicare & Medi-Cal

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking a Network Compliance Manager to oversee regulatory compliance across Commercial, Medicare Advantage, and Medi-Cal networks. You will serve as the primary liaison with state regulators and plan partners, guiding filings and transition planning for provider networks.

You will lead initiatives such as block transfers, termination transitions, member notification processes, and complex compliance challenges, requiring thoughtful judgment and collaboration with

Qualifications

• Bachelor's degree or GED with 4 years of relevant experience in lieu of a degree.
• 10 years of prior relevant experience is preferred.
• 5+ years of progressive experience in health plan compliance required.
• DMHC experience and block transfer experience strongly preferred.
• Strong interpersonal and written communication skills.
• Ability to work independently under limited supervision.
• Detail oriented with ability to manage complexity and shifting priorities.
• Advanced proficiency with MS Office including Word, PowerPoint and Excel.
• CHC designation or related credential preferred.

Responsibilities

• Serve as primary liaison with state regulators and plan partners.
• Ensure regulatory compliance across Commercial, Medicare Advantage, and Medi-Cal.
• Lead regulatory initiatives including block transfers and provider termination planning.
• Oversee member notification processes and required state filings.
• Exercise judgment to resolve complex compliance issues.

Skills

Interpersonal communication

Independent work

Detail oriented

MS Office proficiency

Regulatory compliance

Education

Bachelor's degree

GED or High School Diploma

Tools

MS Office

Job description

Blue Shield of California is seeking a Network Compliance Manager to oversee regulatory compliance across Commercial, Medicare Advantage, and Medi-Cal networks. You will serve as the primary liaison with state regulators and plan partners, guiding filings and transition planning for provider networks.

You will lead initiatives such as block transfers, termination transitions, member notification processes, and complex compliance challenges, requiring thoughtful judgment and collaboration with