Assistant Director Clinical Regulatory Operations

Cambia Health Solutions, Inc.; United States; Hybrid; USD 128,000 - 208,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Cambia Health Solutions, Inc. is seeking an Assistant Director of Clinical Regulatory Operations to lead a regulatory operations team across multiple locations in a hybrid environment.

The role partners with Regulatory Affairs, Legal, Compliance and clinical leaders to drive compliance, quality, and efficiency within CMS, state, NCQA, HIPAA, and contract requirements. You will develop monitoring frameworks, leverage data analytics, and guide cross-functional teams to standardize processes, close

Qualifications

• Bachelor's degree in healthcare or related field; Master's preferred.
• 5 years of leadership experience.
• 7 years of health insurance or managed care experience in regulatory compliance.

Responsibilities

• Identify and operationalize evolving regulatory requirements across HSO program areas.
• Standardize processes across teams to reduce redundancy and improve compliance.
• Lead regulatory compliance programs using PDSA, Lean, Six Sigma.
• Establish audit and monitoring processes with automation and real-time reporting.
• Manage corrective action plans and remediation.
• Lead NCQA accreditation readiness activities.
• Oversee rapid resolution and inter-rater reliability programs.
• Handle management duties including hiring, development, and budgeting.

Skills

Leadership experience

Regulatory compliance

CMS compliance

Regulatory reporting

Data analytics

Project management

Cross-functional collaboration

Policy writing

AI tools familiarity

Education

Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field

Master's degree preferred

Tools

Dashboard development

Workflow automation

Job description

Assistant Director Clinical Regulatory Operations### Assistant Director Clinical Regulatory OperationsApply: Fargo, ND: Salt Lake City, UT: Renton, WA: Medford, OR: Portland, OR: Full time: Posted Yesterday: R-6397**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.* As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.**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%.