Assistant Director Affordability Utilization Management and Appeals

Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Nursing, Pharmacy, Finance, or a related fieldrequired; Master's degree (MBA, MHA, MPH, or equivalent) preferred.
• Eight (8) or more years of progressively responsible leadership experience in healthcare delivery, managed care, health insurance, healthcare consulting, or another complex healthcare environment, including five (5) or more years leading large cross-functional strategic initiatives, enterprise programs, or operational transformation efforts.
• Demonstrated success leading affordability, cost management, value-based care, medical management, provider operations, paymentintegrity, pharmacy, or other complex healthcare operational initiatives.
• Experience developing business cases, managing enterprise portfolios, facilitating executive governance, and driving measurable financial
• and operational outcomes.
• Experience influencing executive leaders and collaboratively with Finance, Actuarial, Clinical Operations, Health Informatics, Product, Technology, Provider Network, and executive leadership.
• Equivalent combinations of education and relevant experience will be considered.
• Skills and Attributes:
• Strategic thinking with the ability to translate enterprise goals into executable initiatives.
• Demonstrated ability to understand complex healthcare systems, identify upstream drivers of cost and quality, and design integrated solutions that optimize performance across clinical, operational, financial, and technology domains.
• Executive presence with exceptional written, verbal, and presentation skills, including the ability to facilitate executive discussions, influence decision making, and communicate effectively with senior leadership.
• Proven ability to influence across organizational boundaries without formal authority.
• Strong business acumen including financial analysis, business case development, financial forecasting, and value realization.
• Demonstrated expertise leading enterprise, cross-functional portfolios involving multiple stakeholders.
• Exceptional facilitation, negotiation, and consensus-building skills.
• Demonstrated ability to simplify complex operational problems into actionable solutions.
• Strong analytical skills with experience using operational metrics, financial analysis, and performance dashboards.
• Experience building governance structures, accountability frameworks, and operating models.
• Experience driving organizational change and leading transformation initiatives.
• Proven ability to develop high-performing teams and foster a culture of accountability and continuous improvement.
• Experience evaluating external solutions, vendor partnerships, and build-versus-buy decisions.
• Proficiency with AI-enabled productivity and analytical tools to improve executive decision making, operational performance,
• and organizational effectiveness
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
• What You Will Do at Cambia:
• Partners with VP and senior leadership to define and execute the Cost Stewardship strategic roadmap, including annual planning, initiative prioritization, and portfolio management across Clinical/Medical Management, Payment Integrity, Network Management, and Pharmacy levers.
• Leads end-to-end initiative lifecycle management by facilitating the pipeline from opportunity identification through execution, ensuring each initiative advances with appropriate rigor, clear milestones, defined ownership, business rationale, and accountability for delivering targeted value.
• Drives performance management and risk mitigation by monitoring execution across the portfolio, proactively identifying dependencies and barriers, escalating blockers through governance channels with recommended interventions, and ensuring timely delivery of savings targets.
• Leads solution development and business case rigor by partnering with Health Informatics, Finance, Actuarial, and cross-functional subject matter experts to translate opportunities into execution-ready initiatives with validated sizing, confidence scoring, clear KPIs, and implementation plans connected to enterprise trend targets.
• Establishes governance, reporting, and decision frameworks by leading Cost Stewardship execution meetings, maintaining a single source of truth for pipeline and performance dashboards, coordinating early engagement across shared services, and preparing executive communications that translate complex data into actionable insights.
• Develops standardized tools and continuous improvement practices including portfolio and project execution templates, business case frameworks, milestone tracking artifacts, and Health Services operating model elements such as governance structures, accountability design, and change management.
• Evaluates vendor partnerships and leads team development by assessing build-versus-buy opportunities, overseeing strategic vendor relationships for performance and value realization, and coaching a high-performing team through clear expectations, professional growth opportunities, and a culture of collaboration and innovation.
• As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.
• FTEs Supervised
• 3-8 Direct FTEs
• #LI-Hybrid
• Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.
• Oregon, Washington, Utah, and Idaho: The expected hiring range is $148,800 - $201,300, the full salary range is $140,000 - $228,000 and the bonus target is 20%.
• North Dakota: The full salary range is $113,780 - $187,737 and the bonus target is 15%.

About Cambia

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Nursing, Pharmacy, Finance, or a related fieldrequired; Master's degree (MBA, MHA, MPH, or equivalent) preferred.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
• Oregon, Washington, Utah, and Idaho: The expected hiring range is $148,800 - $201,300, the full salary range is $140,000 - $228,000 and the bonus target is 20%.
• North Dakota: The full salary range is $113,780 - $187,737 and the bonus target is 15%.