Assistant Director Clinical Regulatory Operations

Cambia Health; Fargo (ND); Hybrid; USD 114,000 - 188,000; Full time

Benefits offered by this job

Hybrid work model

Comprehensive benefits

Job summary

Cambia Health is seeking an Assistant Director of Clinical Regulatory Operations to lead a regulatory operations team across multiple health plan programs. The role focuses on ensuring CMS, state and NCQA compliance while promoting operational excellence and value for members.

The ideal candidate will drive improvement through data analytics, automation and structured improvement methods, while partnering with Legal, Compliance and clinical leaders to align processes across locations and lines

Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field (Master's preferred)
• 5+ years of leadership experience
• 7+ years in health insurance/managed care with regulatory compliance or clinical operations

Responsibilities

• Partner with Regulatory Affairs, Quality, Legal, Compliance and clinical leaders to interpret and operationalize new regulatory requirements across HSO programs.
• Serve as strategic partner to clinical leadership to improve affordability, efficiency, quality and member experience within regulatory guardrails.
• Design and implement regulatory compliance programs using structured improvement models (PDSA, Lean, Six Sigma).
• Establish audit and monitoring processes with automation, dashboards, and real‑time reporting.
• Lead NCQA accreditation readiness activities including gap assessments and mock audits.
• Manage department budget, staffing, and succession planning.

Skills

Regulatory leadership

CMS/NCQA knowledge

Data analytics & dashboards

Regulatory program design

Cross-functional collaboration

Project management

Education

Bachelor's degree in Healthcare Admin / Nursing / Public Health

Tools

AI tools familiarity

Job description

Assistant Director Clinical Regulatory Operations

Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, Fargo offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate. Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Clinical leaders are living our mission to make health care easier and lives better. As a member of the Transformation, Quality, and Learning team, our Assistant Director Clinical Regulatory Operations leads a clinical regulatory operations team that serves as a strategic partner to HSO clinical business leaders - enabling the pursuit of improved affordability, operational efficiency, quality, and member experience within a framework of regulatory compliance. This role ensures all Health Services Operations (HSO) operate in compliance with CMS, state, NCQA, Privacy, and contractual requirements - while applying improvement science to advance operations toward sustainable excellence. The role will partner with Cambia regulatory stakeholders and clinical business owners to identify and operationalize evolving requirements, establish scalable monitoring and remediation frameworks, and facilitate operational simplification by aligning processes across teams and lines of business where appropriate - all in service of creating a person-focused health care experience. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Ready to lead regulatory excellence at the intersection of compliance and innovation during health care's most transformative era? Want to shape how multiple health systems work together-building the compliance framework that enables better care for thousands of members? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, or a related field (Master's preferred)
• 5 years of leadership experience
• 7 years of health insurance or managed care experience focused on regulatory compliance, quality management, or clinical operations - or an equivalent combination of education and experience

Skills and Attributes:

• Demonstrated knowledge of CMS, state, NCQA, HIPAA/Privacy, and managed care contract compliance requirements as applied across Utilization Management & Appeals, Care Management, Pharmacy, and Payment Integrity.
• Ability to interpret complex regulatory requirements and translate them into clear, actionable operational guidance for diverse audiences.
• Demonstrated competency in designing and executing compliance monitoring, auditing, and reporting programs in a health plan or managed care environment.
• Demonstrated knowledge and application of improvement science methodologies (e.g., PDSA, Lean, Six Sigma), with the ability to drive operational improvement beyond compliance monitoring.
• Demonstrated ability to analyze and align operational processes across multiple teams and lines of business to achieve standardization, simplification, and scalability.
• Experience leading cross-functional regulatory implementation efforts in collaboration with clinical operations, legal, compliance, and regulatory affairs.
• Ability to identify compliance gaps, conduct root cause analysis, and lead data-driven remediation across operational teams.
• Experience leveraging automation, data analytics, and technology to enhance compliance monitoring and program effectiveness; familiarity with dashboard development or workflow automation preferred.
• Demonstrated competency in resource and project management, including budgeting, workforce planning, and managing to deliverables.
• Ability to develop and lead teams across multiple locations or remote environments, including hiring, goal setting, coaching, and development.
• Strong written and verbal communication skills, including regulatory memos, executive reporting, and presentations.
• Experience writing policies and procedures and developing monitoring and auditing tools.
• Experience with AI tools and technologies to enhance productivity and decision-making highly desired.

What You Will Do at Cambia:

• Partners with Regulatory Affairs, Quality, Legal, Compliance, and clinical business owners to identify, interpret, and operationalize new and evolving regulatory requirements across all HSO program areas (Utilization Management & Appeals, Care Management, Pharmacy, Payment Integrity).
• Serves as strategic partner to HSO clinical leaders, enabling improved affordability, operational efficiency, quality, and member experience within regulatory guardrails.
• Facilitates operational simplification by systematically comparing and aligning processes across teams and lines of business-standardizing where appropriate to reduce redundancy, scale consistent compliance practices, and streamline operations using improvement science methodologies.
• Designs and executes regulatory compliance programs using structured improvement models (PDSA, Lean, Six Sigma) to drive program maturity and advance operations toward embedded operational excellence.
• Continuously evaluates program efficiency to streamline processes, eliminate waste, and optimize resources.
• Establishes and continuously improves audit and monitoring processes, incorporating automation, dashboards, and real-time reporting in partnership with data, analytics, and technology teams.
• Develops compliance reporting frameworks leveraging automation and data visualization to provide leadership with timely, actionable insights on compliance status, risk exposure, and program performance.
• Manages corrective action plans from internal monitoring, external audits, and accreditation surveys-applying root cause analysis to address systemic drivers and ensure sustainable remediation.
• Collaborates with Cambia Regulatory stakeholders to identify emerging compliance trends, detect risk areas, and recommend proactive mitigation strategies while ensuring legislative, regulatory, and accreditation changes are implemented within required timeframes.
• Leads NCQA accreditation readiness activities including gap assessments, mock audits, and submission preparation.
• Oversees the HSO Rapid Resolution Team managing complex member escalation cases with systematic root cause analysis and trend monitoring.
• Oversees the Clinical Review Inter-rater Reliability program ensuring evidence-based, objective reviews with structured calibration processes, statistically valid sampling, and performance benchmarks aligned with NCQA, URAC, and industry best practices.
• Handles all management responsibilities including performance reviews, development, hiring, coaching, and retention.
• Manages department budget, authorizes expenditures, monitors workforce allocation, and oversees project plans.
• Establishes long-term department goals in conjunction with division leadership and acts as liaison between HSO program areas and enterprise stakeholders.

FTEs Supervised

30 FTEs#LI-HybridPay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Oregon, Washington, Utah, and Idaho: The expected hiring range is $136,000 - $184,000, the full salary range is $128,000 - $208,000 and the bonus target is 20%. North Dakota: The full salary range is $113,780 - $187,737 and the bonus target is 15%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can: Work alongside diverse teams building cutting-edge solutions to transform health care. Earn a competitive salary and enjoy generous benefits while doing work that changes lives. Grow your career with a company committed to helping you succeed. Give back to your community by participating in Cambia-supported outreach programs. Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. Annual employer contribution to a health savings account. Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). Award-winning wellness programs that reward you for participation. Employee Assistance Fund for those in need. Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.