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, Cambia’s 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:
Bachelor’s degree in healthcare or a related field (Master's 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 $134,300 - $181,700 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 $126,000 - $206,000.
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 we're 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:
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:
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.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.