Strategic Network Compliance Leader

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

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.