Provider Network & Compliance Manager

Elevance Health; Los Angeles (CA); Hybrid; USD 78,000 - 121,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase plan

401k contribution

Job summary

Elevance Health in California is seeking a Provider Relationship Account Manager to oversee provider participation changes, regulatory compliance activities, and network initiatives. The role ensures network adequacy, continuity of care, and compliance with DMHC, DHCS, and other standards, serving as a central liaison among internal teams and external regulators.

The position requires a bachelor’s degree, 3 years of customer service with healthcare experience, and strong regulatory and

Qualifications

• Bachelor's degree required; 3+ years of customer service experience including 2 years in healthcare/provider environment.
• Experience with regulatory compliance, accreditation, auditing, and provider networks preferred.
• Strong project management, analytical, regulatory writing, and cross-functional leadership skills preferred.

Responsibilities

• Manage the intake, assessment, tracking, escalation, and resolution of provider participation changes.
• Coordinate network adequacy analyses and regulatory submissions required by DMHC, DHCS, and other applicable oversight entities.
• Coordinate responses to regulatory inquiries and ensure supporting documentation is accurate, complete, and submitted within required timeframes.
• Lead regulatory audits, examinations, accreditation reviews, readiness assessments, and related evidence preparation.
• Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates for regulatory initiatives.
• Interpret applicable laws, regulations, contractual requirements, and accreditation standards and provide guidance to business partners.
• Develop and maintain policies, procedures, audit tools, training materials, metrics, dashboards, and compliance monitoring reports.
• Identify regulatory and operational risks, recommend process improvements, and monitor remediation through completion.
• Collaborate with clinical, quality, care management, health plan, growth, and vendor management teams on regulatory and network initiatives.

Skills

Regulatory compliance

Medicaid experience

Provider networks

Project management

Microsoft Word/Excel

Travel to sites

Education

Bachelor’s degree

Tools

Microsoft Word

Microsoft Excel

Job description

Elevance Health in California is seeking a Provider Relationship Account Manager to oversee provider participation changes, regulatory compliance activities, and network initiatives. The role ensures network adequacy, continuity of care, and compliance with DMHC, DHCS, and other standards, serving as a central liaison among internal teams and external regulators.

The position requires a bachelor’s degree, 3 years of customer service with healthcare experience, and strong regulatory and