Senior Provider Relations & Compliance Lead (Hybrid CA)

Elevance Health; Costa Mesa (CA); Hybrid; USD 96,000 - 151,000; Full time

Job summary

Elevance Health in California is seeking a Provider Relationship Account Manager Senior to oversee provider participation changes, regulatory compliance, and network adequacy. This hybrid role requires in-office presence 1-2 days weekly and proximity to a California office for collaboration and compliance readiness.

Responsibilities include coordinating with Regulatory Affairs, Provider Network Management, and Member Services, ensuring timely regulatory submissions and strong provider relations

Qualifications

• Requires a bachelor’s degree; a minimum of 5 years of customer service experience including 2 years in a healthcare/provider environment.
• Healthcare experience in provider networks or regulatory contexts is highly preferred.
• Regulatory compliance, auditing, and documentation skills are essential.

Responsibilities

• Manage intake, assessment, tracking, escalation, and resolution of provider participation changes.
• Evaluate member and network impacts including continuity of care and provider notices.
• Coordinate network adequacy analyses and regulatory submissions.
• Coordinate responses to regulatory inquiries and ensure documentation is accurate and timely.
• Lead regulatory audits, examinations, and readiness assessments.
• Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates.

Skills

Regulatory compliance

Auditing

Provider networks

Medicaid experience

GeoAccess analysis

Continuity of care

Member communications

Project management

Analytical

Regulatory writing

Cross-functional leadership

Microsoft Word

Microsoft Excel

Travel

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Job description

Elevance Health in California is seeking a Provider Relationship Account Manager Senior to oversee provider participation changes, regulatory compliance, and network adequacy. This hybrid role requires in-office presence 1-2 days weekly and proximity to a California office for collaboration and compliance readiness.

Responsibilities include coordinating with Regulatory Affairs, Provider Network Management, and Member Services, ensuring timely regulatory submissions and strong provider relations