Senior Clinical Regulatory Operations Lead

Cambia Health Solutions; Medford (OR); On-site; USD 128,000 - 184,000; Full time

Benefits offered by this job

Medical benefits

Health Savings Account

Paid time off

401(k) match

Parental leave

Job summary

Cambia Health Solutions seeks an Assistant Director Clinical Regulatory Operations to lead a regulatory operations team ensuring CMS, state, NCQA, and privacy compliance across Health Services Operations. You will partner with stakeholders to drive affordable, high-quality care and streamline processes with improvement science.

The role oversees audits, remediation, and integration of automation and dashboards to deliver timely insights, while managing budgets, workforce planning, and

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.

Responsibilities

• 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).
• 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.

Skills

CMS compliance

NCQA knowledge

HIPAA privacy

Regulatory compliance

Quality management

Cross-functional leadership

Data analysis

Improvement science

Project management

Budgeting

Healthcare administration

Education

Bachelor's in Healthcare Administration

Master's degree preferred

Tools

Dashboards

Job description

Cambia Health Solutions seeks an Assistant Director Clinical Regulatory Operations to lead a regulatory operations team ensuring CMS, state, NCQA, and privacy compliance across Health Services Operations. You will partner with stakeholders to drive affordable, high-quality care and streamline processes with improvement science.

The role oversees audits, remediation, and integration of automation and dashboards to deliver timely insights, while managing budgets, workforce planning, and