Network Compliance Manager, Principal

Blue Shield of CA; Redding (CA); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Blue Shield of California is seeking a Network Compliance Manager, Principal, to lead regulatory compliance initiatives across Commercial, Medicare Advantage, and Medi-Cal provider networks. You will serve as the primary liaison with state regulators and plan partners, overseeing evolving state requirements and essential filings.

The role demands strong leadership, superb communication, and the ability to navigate complex timelines and changing priorities.

Qualifications

• Bachelor’s degree or equivalent with 4 years of additional relevant experience.
• 10 years of prior relevant experience.
• 5+ years of progressive health plan compliance experience.
• DMHC experience and block transfer experience strongly preferred.
• Strong interpersonal and verbal and written communication skills.
• Works independently under limited supervision.
• Detail oriented with the ability to manage complexity, timelines, 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 lines.
• Oversee evolving state requirements and required state filings.
• Help lead regulatory initiatives including block transfers and provider termination transition planning.
• Manage member notification processes and resolve complex compliance issues.

Skills

Regulatory compliance

Communication skills

Leadership

Independence

Time management

MS Office proficiency

Education

Bachelor's degree or high school diploma with 4 years relevant experience

10 years of prior relevant experience

5+ years in health plan compliance

DMHC experience

Block transfer experience

CHC designation preferred

Job description

Your Role

The Network Compliance team collaborates to ensure regulatory compliance with regulations pertaining to HMO, PPO, Medicare, and Medi-Cal provider network disruptions. The Network Compliance Manager, Principal, will report to the Sr. Manager of Network Operations. In this role you will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business. You will help lead critical regulatory initiatives, including block transfers, provider termination transition planning, member notification processes, and required state filings, while exercising judgment to resolve complex compliance issues.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree

  • 10 years of prior relevant experience

  • 5+ years of progressive experience in health plan compliance, required

  • DMHC experience and block transfer experience strongly preferred

  • Strong interpersonal and verbal and written communication skills

  • Works independently under limited supervision

  • Detail oriented and has the ability to deal with complexity, compressed timelines and shifting priorities

  • Advanced proficiency with MS Office products is required, including Word, PowerPoint and Excel.

  • CHC designation or another related credential preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.