Director Clinical Services

Director Clinical Services

Work from home within Oregon, Washington, Idaho or Utah 

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 Clinical Service leaders are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Director of Clinical Services provides leadership and oversight for the clinical teams supporting one or more health plan lines of business (e.g. Government Programs or Group/Commercial). Oversees functions such as care management, disease management, and utilization review. Ensures programs offered are market competitive, compliant with regulatory and accrediting standards, and designed to manage health care costs while achieving quality outcomes. Serves a key member of broader Clinical Services Leadership Team to establish business objectives, allocate resources and drive results. – all in service of creating a person-focused health care experience.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Are you a seasoned clinical leader passionate about creating a person-focused healthcare experience? Do you thrive in a dynamic environment where no two days are the same? Then this role may be the perfect fit.

What You Bring to Cambia: 

Qualifications:  

• Bachelor’s Degree in Nursing (Masters preferred)

• 7 years of progressively responsible clinical care experience

• 5 years of management experience

• 10 years of experience in health plan case management, utilization management or quality management

• Equivalent combination of education and experience

• Current unrestricted Registered Nurse (RN) license

Skills and Attributes: 

• Demonstrated ability to lead high performing teams, manage managers, and direct vendors.

• Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders.

• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.

• Knowledge of health insurance industry trends and technology. 

• Demonstrated ability to create and execute care management and utilization management programs and drive results across internal teams and/or external vendors.

• Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operations. NCQA, URAC and/or HEDIS accreditation experience strongly preferred.

• Ability to decipher and interpret clinical data and deliver presentations to various internal/external audiences related to clinical outcomes.

What You Will Do at Cambia:

• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams.  Aligns team goals with the organization’s vision and strategy. 

• Develops strategies and tactics to effectively manage healthcare costs, improve clinical quality and enhance the member experience for assigned lines of business. 

• Collaborates with Medical Directors, Healthcare Informatics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member.

• Manages the organization by ensuring clear performance expectations along with appropriate skills sets.  Fosters an effective work environment and ensures employees receive recognition, feedback and development.  Participates in organizational talent management and succession planning.

• Determines appropriate staffing levels and resource needs, creates and manages department and/or project budget, allocates resources, and approves expenditures.

• Oversees the development of effective and efficient clinical and operational policies, procedures and standards.  Monitors results and implements process or system changes as needed.

• Ensures clinical programs meet federal and state regulations, accreditation standards, quality metrics, client requirements, and evolving models of care (e.g. accountable care organizations, patient centered homes). 

• Makes recommendations as to the use and selection of external vendors.  Provides clinical leadership and operational oversight to vendors.

FTEs Supervised  

75 - 100

#LI-Remote

The expected hiring range for a Director Clinical Services is $176,000 - $238,100 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 25%.  The current full salary range for this role is $165,000 - $270,000.

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:  

• 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.