Senior Director, Regulatory Affairs – Delegated Services

Dayforce

Senior Director leading regulatory strategy and compliance for delegated healthcare services. Ensuring operational integrity and audit readiness in Medicare and Medicaid frameworks.

Posted 7/29/2026full-timeRemote • Texas • 🇺🇸 United StatesSenior💰 $135,000 - $175,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates extensive expertise in healthcare regulatory strategy, compliance governance, and oversight of delegated services across Medicare, Medicaid, and Commercial lines. Proven ability to lead audit readiness, manage corrective action plans, and ensure alignment with federal and state regulatory requirements.

Highest-signal resume keywords

Healthcare Regulatory AffairsAudit ManagementDelegated Services OversightCompliance GovernancePhysician Licensing Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory Strategy DevelopmentCorrective Action PlanningUtilization Management OversightAudit ReadinessRoot Cause AnalysisCompliance Matrix DevelopmentPolicy DevelopmentRegulatory MonitoringDenials ManagementGrievances Management

Soft Skills

LeadershipCollaborationCommunicationStrategic ThinkingProblem Solving

Tools & Technologies

Regulatory Monitoring SystemsWorkflow Management ToolsAudit Management Software

Industry Keywords

MedicareMedicaidManaged CareCMSNCQAURACDelegation OversightCompliance StandardsAccreditation StandardsState Regulatory Requirements

About the role

Key responsibilities & impact

Lead regulatory strategy, governance, and oversight for delegated services across Medicare, Medicaid, and Commercial lines of business, ensuring alignment with federal, state, payer, and contractual requirements.
Serve as the subject matter expert on full delegation requirements, including delegated utilization management, clinical decision-making oversight, denials, appeals, grievances, and related reporting obligations.
Own enterprise audit readiness for delegated UM functions, including CMS audits, health plan delegation audits, state regulatory reviews, mock audits, gap assessments, tracer development, documentation reviews, and remediation planning.
Lead development, execution, and monitoring of corrective action plans, ensuring root cause analysis, sustainable remediation, and ongoing performance monitoring.
Interpret and operationalize delegated contractual obligations and state-specific regulatory requirements, including utilization management rules, notice requirements, turnaround times, physician reviewer requirements, member protections, and delegation oversight expectations to ensure operational alignment, compliance governance, and audit defensibility.
Establish and maintain a state-by-state regulatory framework, including compliance matrices, workflow requirements, regulatory monitoring systems, and control structure to support multi-state delegated operations.
Develop regulatory risk escalation pathways, governance structures, and remediation strategies for identified compliance vulnerabilities across delegated operations.
Oversee physician licensing compliance for medical directors, peer reviewers, and other clinical staff performing delegated functions, ensuring appropriate state licensure, renewal tracking, exclusions monitoring, and compliance with state-specific reviewer requirements.
Ensure delegated services are structured to comply with federal, state, contractual, and accreditation standards, including coverage determination, appeal, grievance, timeliness, documentation, and oversight expectations.
Provide regulatory leadership for Medicaid delegated services, including interpretation of state-specific Medicaid and managed Medicaid requirements and coordination with plan-specific expectations.
Partner with operations and technology teams to assess, design, and improve technical workflows that support delegated denials, appeals, and grievances processes, including intake, case routing, escalation paths, notices, queue management, documentation, audit trails, and reporting.
Ensure delegated workflows support accurate decision-making, timely processing, complete documentation, and defensible audit outcomes.
Collaborate with legal, compliance, and business leaders on delegation-related contract language, oversight models, and risk mitigation strategies.
Monitor, interpret, and operationalize changes in CMS, state, and payer requirements, including enterprise impact assessment and translate those changes into policies, procedures, system requirements, and operational controls.
Monitor, interpret, and communicate emerging legislative, regulatory, and policy developments across federal, state, payer, and delegated environments, proactively assessing organizational impact and guide strategic readiness.
Support development and maintenance of policies and procedures aligned with applicable regulatory and accreditation standards, including CMS, NCQA, URAC, and payer-specific delegation standards.
Serve as a key point of contact with external health plan partners, auditors, regulators, and accreditation entities related to delegated compliance activities.

Requirements

What you’ll need

10+ years of progressive leadership experience in healthcare regulatory affairs, delegated services oversight, compliance, or managed care operations.
Significant hands-on experience leading and managing audits, including CMS audits, payer delegation audits, and/or state regulatory reviews.
Proven success building and sustaining audit-ready delegated programs, including corrective action planning and remediation management.
Direct experience overseeing or partnering closely on denials, appeals, and grievances operations in a delegated or payer environment.
Experience with physician licensing compliance across multiple states, including oversight of licensure verification, renewals, and state-specific reviewer qualifications.

Benefits

Comp & perks

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Lead regulatory strategy, governance, and oversight for delegated services across Medicare, Medicaid, and Commercial lines of business, ensuring alignment with federal, state, payer, and contractual requirements.
Serve as the subject matter expert on full delegation requirements, including delegated utilization management, clinical decision-making oversight, denials, appeals, grievances, and related reporting obligations.
Own enterprise audit readiness for delegated UM functions, including CMS audits, health plan delegation audits, state regulatory reviews, mock audits, gap assessments, tracer development, documentation reviews, and remediation planning.
Lead development, execution, and monitoring of corrective action plans, ensuring root cause analysis, sustainable remediation, and ongoing performance monitoring.
Interpret and operationalize delegated contractual obligations and state-specific regulatory requirements, including utilization management rules, notice requirements, turnaround times, physician reviewer requirements, member protections, and delegation oversight expectations to ensure operational alignment, compliance governance, and audit defensibility.
Establish and maintain a state-by-state regulatory framework, including compliance matrices, workflow requirements, regulatory monitoring systems, and control structure to support multi-state delegated operations.
Develop regulatory risk escalation pathways, governance structures, and remediation strategies for identified compliance vulnerabilities across delegated operations.
Oversee physician licensing compliance for medical directors, peer reviewers, and other clinical staff performing delegated functions, ensuring appropriate state licensure, renewal tracking, exclusions monitoring, and compliance with state-specific reviewer requirements.
Ensure delegated services are structured to comply with federal, state, contractual, and accreditation standards, including coverage determination, appeal, grievance, timeliness, documentation, and oversight expectations.
Provide regulatory leadership for Medicaid delegated services, including interpretation of state-specific Medicaid and managed Medicaid requirements and coordination with plan-specific expectations.
Partner with operations and technology teams to assess, design, and improve technical workflows that support delegated denials, appeals, and grievances processes, including intake, case routing, escalation paths, notices, queue management, documentation, audit trails, and reporting.
Ensure delegated workflows support accurate decision-making, timely processing, complete documentation, and defensible audit outcomes.
Collaborate with legal, compliance, and business leaders on delegation-related contract language, oversight models, and risk mitigation strategies.
Monitor, interpret, and operationalize changes in CMS, state, and payer requirements, including enterprise impact assessment and translate those changes into policies, procedures, system requirements, and operational controls.
Monitor, interpret, and communicate emerging legislative, regulatory, and policy developments across federal, state, payer, and delegated environments, proactively assessing organizational impact and guide strategic readiness.
Support development and maintenance of policies and procedures aligned with applicable regulatory and accreditation standards, including CMS, NCQA, URAC, and payer-specific delegation standards.
Serve as a key point of contact with external health plan partners, auditors, regulators, and accreditation entities related to delegated compliance activities. 🎯 Requirements
10+ years of progressive leadership experience in healthcare regulatory affairs, delegated services oversight, compliance, or managed care operations.
Significant hands-on experience leading and managing audits, including CMS audits, payer delegation audits, and/or state regulatory reviews.
Proven success building and sustaining audit-ready delegated programs, including corrective action planning and remediation management.
Direct experience overseeing or partnering closely on denials, appeals, and grievances operations in a delegated or payer environment.
Experience with physician licensing compliance across multiple states, including oversight of licensure verification, renewals, and state-specific reviewer qualifications. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Compliance Advisor, Branch Examinations 🔥 12 minutes ago Dayforce 5001 - 10000 👥 HR Tech ☁️ SaaS 🏢 Enterprise Website LinkedIn All Job Openings Compliance Advisor responsible for conducting compliance examinations at Lincoln Investment branch offices. Evaluating adherence to regulations and providing guidance on compliance issues. 🇺🇸 United States – Remote 💰 $1G Post-IPO Debt - Dayforce on 2024-03 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🚔 Compliance Advertising Compliance Analyst 🔥 14 minutes ago Dayforce 5001 - 10000 👥 HR Tech ☁️ SaaS Website LinkedIn All Job Openings Advertising Compliance Analyst supporting financial professionals with compliance solutions to meet regulatory standards. Reviewing communications, developing procedures, and collaborating with various stakeholders. 🇺🇸 United States – Remote 💰 $1G Post-IPO Debt - Dayforce on 2024-03 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🚔 Compliance Analyst – Regulatory Compliance 🔥 1 hour ago Circular Action Alliance 11 - 50 🍽️ Food & Beverage 🏭 Manufacturing 📦 Logistics Website LinkedIn All Job Openings Regulatory Compliance Analyst for National Program Operations Team. Supporting California SB 54 implementation and ensuring compliance with regulatory requirements. 🇺🇸 United States – Remote 💵 $63k - $83k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🚔 Compliance Compliance Manager – Virtual Care System 🔥 4 hours ago PreBorn! 51 - 200 🤝 Non-profit 🤲 Charity 🏥 Healthcare Website LinkedIn All Job Openings Compliance Manager overseeing coding and compliance for PreBorn's Virtual Care System. Leading risk management efforts while advancing maternal health outcomes for high-risk populations. 🇺🇸 United States – Remote 💵 $75k - $80k / year ⏰ Full Time 🟠 Senior 🔴 Lead 🚔 Compliance Senior Director, Global Regulatory Strategy Lead – FDA Regulatory SME 🔥 7 hours ago AbbVie 10,000+ employees 🏥 Healthcare 💼 Consulting 🏭 Manufacturing Website LinkedIn All Job Openings Senior Director responsible for global regulatory strategy and FDA compliance at AbbVie. Overseeing product development and providing expert regulatory guidance across therapeutic areas. 🇺🇸 United States – Remote 💵 $206.5k - $393k / year ⏰ Full Time 🟠 Senior 🚔 Compliance 🦅 H1B Visa Sponsor View More Compliance Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs