Assistant Director – Clinical Regulatory Operations

Cambia Health Solutions

. Lead a clinical regulatory operations team serving as a strategic partner to HSO clinical business leaders .

Posted 10/24/2026full-timeUnited StatesLead💰 $113,780 - $208,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in regulatory compliance within healthcare, utilizing methodologies such as PDSA, Lean, and Six Sigma to enhance operational efficiency and compliance monitoring. Proven leadership in managing clinical regulatory operations teams and developing compliance reporting frameworks.

Highest-signal resume keywords

Regulatory Compliance ManagementPDSA, Lean, Six Sigma MethodologiesHealth Insurance Regulatory KnowledgeCross-Functional Team LeadershipRoot Cause Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceQuality ManagementClinical OperationsCompliance MonitoringAuditingData AnalyticsProcess AlignmentPerformance ManagementBudgetingWorkforce Planning

Soft Skills

Strong Communication SkillsLeadershipCoachingTeam DevelopmentProblem-Solving

Tools & Technologies

Automation ToolsDashboardsReal-Time ReportingMonitoring Tools

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
Identify, interpret, and operationalize evolving regulatory requirements across Utilization Management & Appeals, Care Management, Pharmacy, and Payment Integrity
Facilitate operational simplification by comparing and aligning processes across teams and lines of business
Design and execute regulatory compliance programs using PDSA, Lean, and Six Sigma methodologies
Establish and improve audit and monitoring processes using automation, dashboards, and real-time reporting
Develop compliance reporting frameworks and provide leadership with insights on compliance status, risk exposure, and program performance
Manage corrective action plans from monitoring, audits, and accreditation surveys
Conduct root cause analysis and recommend proactive compliance mitigation strategies
Lead NCQA accreditation readiness activities, 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
Manage performance reviews, development, hiring, coaching, retention, department budget, expenditures, workforce allocation, and project plans
Establish long-term department goals and act as liaison between HSO program areas and enterprise stakeholders
Supervise 30 FTEs

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
Experience across Utilization Management & Appeals, Care Management, Pharmacy, and Payment Integrity
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 methodologies
Experience aligning operational processes across multiple teams and lines of business
Experience leading cross-functional regulatory implementation efforts
Ability to conduct root cause analysis and lead data-driven remediation
Experience with automation, data analytics, and technology for compliance monitoring
Resource and project management experience, including budgeting and workforce planning
Experience developing and leading teams across multiple locations or remote environments
Strong written and verbal communication skills
Experience writing policies and procedures and developing monitoring and auditing tools
Background check required
Ability to meet wired internet requirements for work-from-home options
Personal mobile device required for Multi-Factor Authentication

Benefits

Comp & perks

Competitive salary
Bonus opportunities
Market-leading 401(k) with a significant company match
Potential discretionary 401(k) contribution based on company performance, with no vesting period
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
Up to 12 weeks of paid parental time off, subject to eligibility
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work from home options for most roles
Employee resource groups
Cambia-supported community outreach opportunities
Career growth and professional development support