Sr. Manager, Mandates Control bei Blue Shield of California Group

Your Work

In this role, you will:

• Develop, implement, and provide day-to-day leadership for processes and tools to support and enhance Mandates Control Group operations

• Ensure mandate impacts are appropriately scoped at the enterprise level and selected compliant options are legally compliant, fiscally responsible, and operationally sustainable

• Ensure impacted business units and stakeholders, business impact statements, identified risks and mitigation plans are documented in a controlled document

• Advise business areas on mandate compliant options; ensure implementation timing, risks and benefits are identified, escalated, and mitigated

• Serve as an escalation point for at risk or non-compliant mandates

• Recognize where compliance is met or corrective action plans are implemented to close identified gaps

• Manage and monitor work of Mandates Control Group staff, providing coaching, guidance and leadership

• Support ongoing alignment with Blue Shield of CA and Blue Shield of CA Promise strategy and company objectives, as well as interdependencies across business units

• Advance a culture of business accountability and solve for gaps in business accountability for mandates compliance

• Advocate and influence across the organization to drive key initiatives of the Mandates Control Group

• Perform other duties as assigned

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience and minimum 10-years prior relevant experience, including 4 years of management experience 

• Requires deep understanding of health insurance operations, healthcare compliance, mandates, regulations, and legislative requirements across all lines of business (commercial, Covered CA, self-funded, and Medicare)

• Requires deep understanding of health insurance operations, healthcare compliance, mandates, regulations, and legislative requirements of the Department of Health Care Services and Medi-Cal

• Requires practical knowledge in leading and managing the execution of processes, projects, and tactics within Mandates

• Requires advanced technical and functional expertise, business acumen, financial analysis skills, risk management, delegation skills, critical thinking, and decision-making skills

• Requires full understanding of applicable legislation/regulations and has demonstrated experience in ensuring departmental compliance

• Requires thorough knowledge of the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes

• Extensive experience in a legal or compliance department in a managed care organization preferred. 

   

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. 

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!  

Our Values: 

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. 
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:

o   Member-facing and approved out-of-state roles remain remote.

o   Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o   For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

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. 

Equal Employment Opportunity:

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.