Network Compliance Manager — Hybrid Regs & Liaison

Blue Shield of California; Cameron Park (CA); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Blue Shield of California seeks a Network Compliance Manager/Principal to lead regulatory compliance efforts across Commercial, Medicare Advantage, and Medi-Cal lines. You will serve as the main liaison with state regulators and plan partners, guiding complex regulatory initiatives like block transfers and provider termination planning.

The role emphasizes collaborating with leadership, managing state filings, and ensuring adherence to evolving requirements.

Qualifications

• Minimum 10 years of experience in health plan compliance.
• 5+ years of progressive experience in health plan compliance.
• DMHC experience strongly preferred.
• Strong interpersonal and verbal and written communication skills.
• Advanced proficiency with MS Office (Word, PowerPoint, Excel).
• CHC designation or related credential preferred.

Responsibilities

• Serve as the primary liaison with state regulators and plan partners.
• Oversee compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal.
• Lead regulatory initiatives including block transfers and provider termination transition planning.
• Manage member notification processes and required state filings.

Skills

Communication

Independent work

Detail oriented

MS Office

Regulatory knowledge

Education

Bachelor’s degree

DMHC experience

Job description

Blue Shield of California seeks a Network Compliance Manager/Principal to lead regulatory compliance efforts across Commercial, Medicare Advantage, and Medi-Cal lines. You will serve as the main liaison with state regulators and plan partners, guiding complex regulatory initiatives like block transfers and provider termination planning.

The role emphasizes collaborating with leadership, managing state filings, and ensuring adherence to evolving requirements.