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.

• 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