Cambia Health Solutions, Inc.
Program Director Accreditation and Delegation
Cambia Health Solutions, Inc., Renton, Washington, United States, 98056
**Build a career with purpose. Join our**
**to create a person-focused and economically sustainable health care system.*** 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* 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* 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* 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.* 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.Everyone is a health care consumer deserving of a simpler, more personalized experience.
is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit
serving over 3 million Americans.Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices..### *Information about how Cambia Health Solutions collects, uses, and discloses information is available in our .* #J-18808-Ljbffr
**to create a person-focused and economically sustainable health care system.*** 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* 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* 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* 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.* 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.Everyone is a health care consumer deserving of a simpler, more personalized experience.
is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit
serving over 3 million Americans.Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices..### *Information about how Cambia Health Solutions collects, uses, and discloses information is available in our .* #J-18808-Ljbffr