Clinical Regulatory Operations Leader

Cambia Health Solutions; Renton (WA); Hybrid; USD 128,000 - 208,000; Full time

Benefits offered by this job

Competitive benefits

Hybrid work model

Career growth opportunities

Job summary

Cambia Health Solutions is seeking an Assistant Director Clinical Regulatory Operations to lead a cross-functional team ensuring CMS, state, NCQA, and HIPAA compliance while driving performance improvements across Utilization Management, Care Management, Pharmacy, and Payment Integrity.

The role partners with Legal, Compliance, and Regulatory Affairs to translate complex regulations into actionable operational guidance, while leveraging automation and dashboards to monitor risk and program

Qualifications

• Bachelor's degree in healthcare-related field required; master's preferred.
• Minimum 5 years of leadership experience in health services operations.
• At least 7 years in health insurance or managed care with regulatory focus.

Responsibilities

• Partner with Regulatory Affairs, Quality, Legal, Compliance to interpret and operationalize new regulations.
• Standardize processes across teams to reduce redundancy and improve compliance.
• Design and execute compliance programs using Lean, Six Sigma, and PDSA methods.
• Develop automated audits and dashboards for real-time compliance insights.
• Manage corrective action plans and drive sustainable remediation.

Skills

CMS compliance

HIPAA/Privacy

Regulatory compliance

Quality management

Improvement science

Data analytics

dashboards

Cross-functional leadership

Project management

Education

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

Master's degree preferred

Job description

Cambia Health Solutions is seeking an Assistant Director Clinical Regulatory Operations to lead a cross-functional team ensuring CMS, state, NCQA, and HIPAA compliance while driving performance improvements across Utilization Management, Care Management, Pharmacy, and Payment Integrity.

The role partners with Legal, Compliance, and Regulatory Affairs to translate complex regulations into actionable operational guidance, while leveraging automation and dashboards to monitor risk and program