Network Compliance Manager, Principal

The Network Compliance team collaborates to ensure regulatory compliance with regulations pertaining to HMO, PPO, Medicare, and Medi-Cal provider network disruptions. The Network Compliance Manager, Principal, will report to the Sr. Manager of Network Operations. In this role you will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business. You will help lead critical regulatory initiatives, including block transfers, provider termination transition planning, member notification processes, and required state filings, while exercising judgment to resolve complex compliance issues., Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

• Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• 10 years of prior relevant experience
• 5+ years of progressive experience in health plan compliance, required
• DMHC experience and block transfer experience strongly preferred
• Strong interpersonal and verbal and written communication skills
• Works independently under limited supervision
• Detail oriented and has the ability to deal with complexity, compressed timelines and shifting priorities
• Advanced proficiency with MS Office products is required, including Word, PowerPoint and Excel.
• CHC designation or another related credential preferred

El Dorado Hills, CA / Oakland, CA / Long Beach, CA / Lodi, CA / Rancho Cordova, CA / Redding, CA / San Diego, CA / Woodland Hills, CA …View All