Hybrid Clinical Regulatory Operations Lead

Cambia Health

Burlington (WA)

Hybrid

USD 128,000 - 208,000

Full time

9 days ago

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Job summary

Cambia Health seeks an Assistant Director Clinical Regulatory Operations to lead a regulatory team ensuring CMS, NCQA, and privacy compliance while driving improvements in affordability, efficiency, quality, and member experience. This role partners with Regulatory Affairs, Legal, and Clinical Operations across multiple HSO programs.

The position emphasizes improvement science, data analytics, and scalable processes to standardize practices, reduce waste, and enhance performance.

Qualifications

Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field (Master's preferred).
5 years of leadership experience.
7 years in regulatory compliance, quality management, or clinical operations.

Responsibilities

Partner with Regulatory Affairs, Quality, Legal, Compliance, and clinical business owners to interpret and operationalize new regulatory requirements across all HSO program areas (Utilization Management & Appeals, Care Management, Pharmacy, Payment Integrity).
Serve as strategic partner to HSO clinical leaders, enabling improved affordability, operational efficiency, quality, and member experience within regulatory guardrails.
Facilitate operational simplification by aligning processes across teams and lines of business to reduce redundancy and standardize compliance practices.
Design and execute regulatory compliance programs using structured improvement models (PDSA, Lean, Six Sigma) to drive maturity and embedded excellence.