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Network Compliance Manager, Principal

Company: Blue Shield of California
Location: Woodland Hills
Posted on: June 12, 2021

Job Description:

Job Summary

Blue Shield of California is seeking a Network Compliance Manager, Principal within Health Solutions.

Our Provider Network Contracting Team (Network Performance Analysis Contracts), is responsible for developing, maintaining, and managing the relationship with Blue Shield's network of physicians, hospitals, ambulatory surgery centers, HMO IPA's, and medical groups.

Our team focuses on provider network performance analysis, reporting, and consulting. Some of our key responsibilities are:

  • Provide consultative services to Blue Shield's key hospital contract negotiations using robust analytic tools and analyses--strategic contract roadmap, negotiation factsheets, and presentations of key market and performance indicators.
  • Provide analytic and consultative support to meet the provider network regulatory requirements.
  • Develop and maintain centralized databases and reports to measure network performance.
  • Summarize and distribute competitive benchmarking reports.
  • Manage several provider network management programs like network discount and performance guarantees for employer accounts.
  • Manage the nuts & bolts standardized Model Contracts and amendments.


Manages and supports the HCQA organization in complying with, as well as the ongoing preparation, testing and monitoring of conformance to, the requirements of government regulations and/or regulatory agencies as it relates to network management.

  • Develop and implement end to end processes within network management for new regulatory reporting to ensure compliance with regulators (60%)
  • Lead and manage cross-functional workgroups with key stakeholders needed to support the development, implementation and monitoring of the required activity. Ensure all output meets the high expectations of internal and external clients.
  • Develop monitoring practices and timelines associated with the required reporting
  • Drive high-quality work products within expected timeframes.
  • Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes.
  • Summarizes, presents findings and recommendations to stakeholders (may include Leadership).
  • Facilitates discussions to secure alignment on go forward path and timeline.
  • Analyze new regulation/requirements and formulate path forward identifying needs and gaps to be successful.
  • Creation of documents and procedures demonstrating "being audit ready at all times".
  • May perform project management duties including the creation of status reports, work plans and presentation

  • Build and manage relationship with multiple stakeholders (15%)
  • Manage expectations of the stakeholders/clients.
  • Collaborate with other departments to define deliverables, develop solutions, action plans (may involve enhancing and improving a current process).
  • Provide thought-leadership in on-going measurement and analysis.

  • Process improvement (15%)
  • Provide recommendations on improving the current process. Coordinate process improvement with other departments. Identify opportunities to improve efficiency and quality and make recommendations to key stakeholders to enhance the current workflow/process.
  • Influence business partners and stakeholders to drive change toward a greater effectiveness and efficiency.

  • People Leadership: manage the professional development of the team (5%)
  • Foster an innovative and inclusive team-oriented work environment.
  • Play an active role in counseling, mentoring, and developing analysts within the organization.

  • Stay abreast of current Blue Shield, Healthcare business and industry trends relevant to HCQA. (5%)

Knowledge and Experience

  • Bachelor's degree with 10 years related experience in the healthcare industry, preferably with prior experience at a health plan or healthcare or strategy consulting firm; MPH, MBA or advanced degree with 7 years of related experience OR equivalent combination of education/experience.
  • Experience as a manager.
  • 10+ years' experience in healthcare and/or consulting environment, preferred.
  • Regulatory filing/compliance and Healthcare Reform knowledge and experience, preferred.
  • Experience in compliance activities.
  • Ability to influence and drive decision making among all levels of stakeholders.
  • Strong knowledge of provider networks and healthcare system.
  • Strong interpersonal skills, ability to work effectively and build relationships with subordinates, peers, senior staff, cross functional teams.
  • Able to lead and influence cross-functional teams, including teams with Senior Leadership involvement or oversight.
  • Strong analytical, problem solving, and critical thinking skills. Able to navigate ambiguous problems and breakdown complex issues into manageable chunks for structured problem solving
  • Strong oral and written communication skills.
  • Regulatory filing/compliance and Healthcare Reform knowledge and experience, preferred.

Additional Information

  • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
  • Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

  • EEO Footer: 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.
  • Requisition ID: 21001P0
  • Posting Date: May 19, 2021
  • Schedule: Full-time

Keywords: Blue Shield of California, Los Angeles , Network Compliance Manager, Principal, Other , Woodland Hills, California

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