Program Director Accreditation and Delegation

Cambia Health • Tacoma, WA

49d • Hybrid

About The Position

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.

Requirements

• 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.
• 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
• 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

Nice To Haves

• A Certified Professional in Healthcare Quality (CPHQ) is preferred
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• 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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees