Program Director Accreditation and Delegation

Program Director Accreditation and Delegation

Hybrid in Renton WA or Portland OR

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day Cambias dedicated team of Program Directors are living our mission to make health care easier and lives better. As a member of the Health Care Services team our Program Director Accreditation and Delegation plans directs and manages enterprise-wide quality management and improvement initiatives that drive clinical excellence and operational performance across the organization while overseeing accreditation delegation and quality of care activities. This position provides strategic leadership to ensure operational and procedural compliance with regulatory requirements for Health Care Services. The Program Director serves as a senior leader representing the department in interactions with all levels of management vendor partners providers government officials accrediting agencies and external consultants all in service of making our members health journey easier.

Do you thrive in roles where you influence strategy across an entire organization Are you looking for a position where your decisions directly impact clinical excellence and member outcomes Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelors degree in healthcare or a related field (Masters is preferred)

• 8 years of leadership experience

• 7 years of insurance industry experience or an equivalent combination of education and experience.

• A Certified Professional in Healthcare Quality (CPHQ) is preferred

Skills and Attributes:

• In-depth knowledge of managed care principles health insurance industry trends and technology with demonstrated application of regulatory and quality standards including Medicare URAC NCQA and other accreditation requirements

• Extensive experience applying quality management and improvement methodologies (Lean Six Sigma PDSA cycles evidence-based frameworks) with successful URAC or NCQA accreditation process experience

• Advanced competency in pulling managing organizing and analyzing data to surface actionable insights

• Ability to write policies and procedures develop monitoring/auditing tools and use judgment and knowledge of standards to identify scenarios requiring delegation oversight

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

• Proven ability to develop and lead teams across multiple locations or remote settings including hiring goal setting coaching and developing supervisors and employees while managing resources budgets and deliverables

• Strong verbal and written communication and presentation skills with ability to negotiate and resolve complex sensitive issues diplomatically and persuasively across diverse internal and external contacts

• Strategic thinking capability to independently identify issues opportunities gaps and effective solutions while collaborating cross-functionally to drive innovative initiatives and improve processes and results

• Advanced analytical skills to analyze complex situations learn quickly synthesize solutions and action plans and use thorough business understanding to influence initiatives

What You Will Do at Cambia:

• Leads development and execution of compliance quality and delegation policies while designing and implementing division and corporate-level projects related to accreditation and delegation activities

• Establishes long-term departmental goals in conjunction with division leadership maintains quality management frameworks that support continuous improvement culture and drives best practice adoption across all business functions

• Communicates and interprets laws regulatory procedures and accreditation standards while ensuring legislative regulatory and accreditation changes are promptly identified and implemented across the organization

• Develops maintains and revises policies procedures and audit tools for oversight of delegated functions including credentialing utilization management case management appeals claims and network management

• Conducts periodic oversight reviews of delegated entities prepares final reports identifying deficiencies develops corrective action plans with timelines and escalates mandatory standard deficiencies while monitoring entity performance

• Champions quality improvement best practices by mentoring team members in QI methodologies (Lean Six Sigma PDSA cycles) fostering data-driven decision making and leading projects that drive measurable organizational transformation

• Collaborates with leadership and cross-functional teams to identify improvement opportunities serves as primary quality management subject matter expert providing guidance across departments and facilitates knowledge sharing and best practice dissemination

• Develops and executes quality management strategies aligned with organizational goals monitors quality trends analyzes performance data and recommends corrective actions to senior leadership while ensuring regulatory compliance and driving innovation

• Manages financial targets department budget and workforce allocation while overseeing project plans to ensure deliverables meet compliance and regulatory standards

• Defines business requirements for delegation-related reporting and data systems manages design and control of delegation reporting systems and tracks corrective action plans from internal monitoring and external audits

FTEs supervised

3-10

#LI-Hybrid

The expected hiring range for a Program Director is $134300 - $181700 depending on skills experience education and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $126000 - $206000.

About Cambia

Working at Cambia means being part of a purpose-driven award-winning culture built on trust and innovation anchored in our 100 year history. Our caring and supportive colleagues are some of the best and brightest in the industry innovating together toward sustainable person-focused health care. Whether were helping members lending a hand to a colleague or volunteering in our communities our compassion empathy and team spirit always shine through.

Why Join the Cambia Team

At Cambia you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match bonus opportunities and more.

In exchange for helping members live healthy lives we offer benefits that empower you to do the same. Just a few highlights include:

• Medical dental and vision coverage for employees and their eligible family members including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.