Assistant Director, Clinical Regulatory Operations

Cambia Health Solutions

Cambia health care leader overseeing clinical regulatory compliance across HSO programs. Aligning operations, audits, remediation, accreditation readiness, and teams across multiple offices.

Posted 8/13/2026full-timeFargo • North Dakota, Oregon, Utah, Washington • 🇺🇸 United StatesLead💰 $113,780 - $208,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in regulatory compliance, quality management, and clinical operations within health insurance or managed care environments. Proficient in leading cross-functional teams, designing compliance programs, and utilizing methodologies such as PDSA, Lean, and Six Sigma to enhance operational efficiency.

Highest-signal resume keywords

Regulatory Compliance ManagementPDSA, Lean, Six Sigma MethodologiesHealth Insurance Regulatory KnowledgeData Analytics and Dashboard DevelopmentLeadership and Team Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceQuality ManagementClinical OperationsRoot Cause AnalysisCompliance MonitoringAuditing ProgramsBudget ManagementProject ManagementPolicy DevelopmentData Visualization

Soft Skills

Strong Communication SkillsTeam LeadershipCross-Functional CollaborationProblem-SolvingCoaching and Mentoring

Tools & Technologies

Automation ToolsData Analytics SoftwareDashboard Development ToolsAI Tools and TechnologiesWorkflow Automation

Industry Keywords

CMS ComplianceNCQA AccreditationHIPAA ComplianceManaged CareUtilization ManagementCare ManagementPharmacy CompliancePayment Integrity

About the role

Key responsibilities & impact

Lead a clinical regulatory operations team serving as a strategic partner to HSO clinical business leaders
Partner with Regulatory Affairs, Quality, Legal, Compliance, and clinical business owners to interpret and operationalize regulatory requirements
Enable affordability, operational efficiency, quality, and member experience within regulatory guardrails
Compare and align processes across teams and lines of business to standardize, simplify, and scale compliance practices
Design and execute regulatory compliance programs using PDSA, Lean, and Six Sigma
Evaluate program efficiency, streamline processes, eliminate waste, and optimize resources
Establish and improve audit and monitoring processes using automation, dashboards, and real-time reporting
Develop compliance reporting frameworks and data visualizations for leadership
Manage corrective action plans from monitoring, audits, and accreditation surveys using root cause analysis
Identify emerging compliance trends and recommend proactive mitigation strategies
Lead NCQA accreditation readiness, including gap assessments, mock audits, and submission preparation
Oversee the HSO Rapid Resolution Team handling complex member escalation cases
Oversee the Clinical Review Inter-rater Reliability program, including calibration, sampling, and performance benchmarks
Handle performance reviews, development, hiring, coaching, and retention
Manage the department budget, expenditures, workforce allocation, and project plans
Establish long-term department goals and liaise between HSO program areas and enterprise stakeholders
Supervise 30 FTEs and provide direction toward shared goals

Requirements

What you’ll need

Bachelor's degree in Healthcare Administration, Nursing, Public Health, or a related field
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
Knowledge of CMS, state, NCQA, HIPAA/Privacy, and managed care contract compliance requirements
Knowledge across Utilization Management & Appeals, Care Management, Pharmacy, and Payment Integrity
Ability to interpret complex regulatory requirements and translate them into actionable operational guidance
Experience designing and executing compliance monitoring, auditing, and reporting programs in a health plan or managed care environment
Knowledge and application of PDSA, Lean, or Six Sigma improvement methodologies
Ability to align processes across multiple teams and lines of business
Experience leading cross-functional regulatory implementation efforts
Ability to identify compliance gaps, conduct root cause analysis, and lead data-driven remediation
Experience with automation, data analytics, dashboard development, or workflow automation
Resource and project management competency, including budgeting and workforce planning
Ability to develop and lead teams across multiple locations or remote environments
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 highly desired
Must reside within commutable distance of a listed office or be willing to relocate
Background check required
Wired internet connection with minimum 5Mb upload and 10Mb download speeds for work-from-home arrangements
Access to a personal mobile device for MFA setup

Benefits

Comp & perks

Competitive base pay
Market-leading 401(k) with a significant company match
Bonus opportunities
Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
Annual employer contribution to a health savings account
Generous paid time off varying by role and tenure
10 company-paid holidays
Market-leading retirement plan including company match on employee 401(k) contributions
Potential discretionary retirement contribution based on company performance, with no vesting period
Up to 12 weeks of paid parental time off, subject to 12 months of continuous service eligibility
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work from home options for most roles, subject to wired internet requirements
Employee resource groups
Cambia-supported outreach programs
Personal mobile device access for Multi-Factor Authentication
Accommodation support for the application process