Network Compliance Manager, Principal

Your Role

The Network Compliance team works closely with various departments within Blue Shield of California and Blue Shield of California Promise Health Plan, as well as with State regulators to ensure regulatory compliance requirements are met relative to provider networks. The Network Compliance Manager, Principal will report to the Senior Director, Network Compliance. In this role, you will manage all aspects of assigned Commercial and Medi-Cal Block Transfer Filing submissions for regulatory review and approval, including member Transition Plans, and related member notification processes resulting from Hospital and Medical Group contract terminations. You will also support annual Timely Access Compliance Reporting to the California Department of Managed Health Care and the Annual Network Review submission to the California Department of Insurance.

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 10 years of prior relevant experience
• Requires ability to communicate with executive leadership regarding matters of significant importance to the organization
• Requires strong technical writing skills
• Requires mastery level knowledge of job area typically obtained through advanced education combined with experience, including knowledge of project management
• Ability to communicate and influence internal and external parties including state regulators, vendors, Plan Partners, and clinicians
• Certified in Healthcare Compliance (CHC) designation is preferred