Shelley Rouillard checks up on health plans in California

The gig: As director of the California Department of Managed Health Care, Shelley Rouillard is the chief regulator for health plans that cover more than 21 million Californians. She's also a major player in the state's implementation of the federal health law.

Bicoastal: Rouillard, 58, was born in Los Angeles but spent much of her childhood in New England following the career moves of her father, an Episcopal priest and college chaplain. She wasn't happy about moving to a tiny town in New Hampshire after her freshman year in high school, but it taught her a valuable lesson. "You just have to find the silver lining when bad things happen," Rouillard said.

At a small school, she quickly became a student leader as yearbook editor and captain of the basketball team. Growing up, she thought women were limited in their career choices to teacher, nurse or social worker. She wasn't interested in the classroom and couldn't stand blood, so she got her bachelor's degree in social work at Rutgers University in New Jersey.

Trophy job: She took a yearlong break during college to return to Los Angeles. Through a family friend, she landed a job doing engraving work at a badge and trophy shop. She recalls drawing the Ralphs grocery store logo hundreds of times for employee name tags. Rouillard saw the value of developing a skill that makes you stand out. Back at college, she found work at another trophy shop to help pay her tuition. "I realized how important it was to have a skill you could take anywhere," she said.

Organizing change: After college, Rouillard returned to the Golden State in 1979 and put down roots in Santa Barbara. She held jobs at a senior day-care center and later led a nonprofit program distributing food and other assistance to the poor. She also became more active as a community organizer. The rents in her apartment building went up 50% one year, so she helped organize the Santa Barbara Tenants Union to negotiate with landlords.

Rouillard developed a knack for bringing people together to confront a common problem. "People who didn't have a lot of power and information needed to band together to make it better," she recalls.

Campaign office: Those experiences led her to local politics. She ran twice unsuccessfully for the Santa Barbara City Council in 1983 and 1985, enduring some personal attacks along the way. "You have to develop a thick skin," Rouillard said.

Capital move: Her campaigns behind her and turning 30, she paused to reflect on what her next career step should be. She decided her job opportunities might be limited in Santa Barbara so she headed to Sacramento for a lobbying job with a legal aid group. Then she got a taste of the private sector negotiating contracts with hospitals and physician groups for a company in the insurance industry.

Patient advocate: One of her big breaks came in 1996 when Peter Lee called. Lee, the current director of California's Obamacare exchange, tapped Rouillard to found the Health Rights Hotline in the Sacramento area. That consumer hot line became the model for her current agency's help center, the prime clearinghouse for patients' health insurance complaints statewide.

Early on, Rouillard said, she saw the value of paying close attention to consumer gripes and analyzing them for signs of systemic issues that need to be addressed. She left the hot line after a decade for a state job overseeing health plans for low-income children and people with preexisting medical conditions.