Regulatory Network Compliance Leader

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 140,000 - 210,000; Full time

Benefits offered by this job

Hybrid schedule

Job summary

Blue Shield of California is seeking a Network Compliance Manager, Principal, to join the Network Compliance team in Los Angeles. You will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing evolving state requirements 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

• Strong interpersonal and verbal and written communication skills.
• Works independently under limited supervision.
• Detail oriented and able to handle complexity and shifting priorities.
• Advanced proficiency with MS Office (Word, PowerPoint, Excel).
• DMHC experience and block transfer experience strongly preferred.

Responsibilities

• Serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships.
• Oversee compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business.
• Lead regulatory initiatives including block transfers, provider termination transition planning, member notification processes, and required state filings, while exercising sound judgment to resolve complex issues.
• Collaborate with leadership to develop leaders and sustain high-performing teams.

Skills

communication skills

independent work

attention to detail

MS Office proficiency

DMHC experience

block transfer experience

Education

10 years of prior relevant experience

5+ years of health plan compliance experience

CHC designation or related credential

Job description

Blue Shield of California is seeking a Network Compliance Manager, Principal, to join the Network Compliance team in Los Angeles. You will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines.

You will lead regulatory initiatives including block transfers, provider termination transition planning, member notification processes, and