Network Compliance Manager, Principal

Blue Shield of California • El Dorado, AR

24d • Hybrid

About The Position

The Network Compliance Manager, Principal, serves as a primary liaison with state regulators and plan partners, maintaining regulatory relationships and overseeing compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business. The role reports to the Sr. Manager of Network Operations and helps lead regulatory initiatives involving block transfers, provider termination transition planning, member notifications, and required state filings. The position requires exercising judgment to resolve complex compliance issues and improve processes and systems. The role follows a hybrid workplace model, generally requiring employees to work in 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.

Requirements

• Bachelor’s degree, or a high school diploma/GED plus four years of additional relevant experience in lieu of a degree.
• 10 years of prior relevant experience.
• At least 5 years of progressive experience in health plan compliance.
• Required DMHC experience and block transfer experience are strongly preferred.
• Strong interpersonal, verbal, and written communication skills.
• Ability to work independently under limited supervision.
• Detail-oriented, with the ability to handle complexity, compressed timelines, and shifting priorities.
• Advanced proficiency with Microsoft Office products, including Word, PowerPoint, and Excel.

Nice To Haves

• CHC designation or another related credential.
• DMHC experience.
• Block transfer experience.

Responsibilities

• Develop and sustain positive relationships with state regulators, including DMHC, CDI, and DHCS, and plan partner LA Care; serve as a project contact with authority to exercise judgment in resolving concerns for the company.
• Operationalize new and existing state requirements affecting Commercial, Medicare Advantage, and State-Sponsored Business.
• Manage commercial and state-sponsored Block Transfer and Timely Access Report filings for state review, including transition planning due to network provider terminations and related member notification processes.
• Assist other departments with compliance-related tasks, including enrollee reassignments, Timely Access Reporting filings, Material Modification Filings, and other state filings.
• Manage compliance reporting for commercial and state-sponsored business, including Timely Access Reporting and related analysis, and present results to internal departments, committees, and external organizations.
• Develop and update policies and procedures related to state filing requirements; submit policies for review and respond to comments or objections.
• Ensure compliance with state and federal orders and find solutions that optimize company operations while meeting imposed conditions or undertakings.
• Provide guidance, direction, training, and assistance on matters related to regulators.
• Proactively improve existing processes and systems using conceptualization, reasoning, and interpretation; results may serve as precedent for future decisions.

What This Job Offers

• Job Type: Full-time
• Career Level: Principal