Assistant Director Affordability Utilization Management and Appeals

Assistant Director Affordability Utilization Management and Appeals Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale offices. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate.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 Health Service Organization (HSO) leaders are living our mission to make health care easier and lives better. As a member of the Affordability function and Health Services Operations team, our Assistant Director of Affordability Utilization Management and Appeals provides leadership for the Affordability Program Office and/or one or more Affordability Levers, ensuring disciplined execution of the enterprise affordability strategy. Responsibilities include leading the end-to-end affordability portfolio, from opportunity identification and solution design through business case development, contracting, implementation, performance management, and value realization. The Assistant Director partners with Affordability Owners and cross-functional leaders to establish priorities, align resources, remove barriers, and drive accountability for delivering measurable affordability outcomes. This role also advances standardized governance, portfolio management, and operating practices that enable consistent execution, transparency, and sustainable enterprise value - 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 ready to lead strategic initiatives that directly reduce health care costs and make coverage more affordable for thousands of members? Do you thrive in a leadership role where you can drive measurable impact across the entire lifecycle-from identifying opportunities to realizing value? Then this role may be the perfect fit. What You Bring to Cambia: 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 financialand 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 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. National pay structure - applies to the Boise, Portland, Salem, Seattle/Renton/Tacoma, Burlington, Vancouver, and Salt Lake City metro areas. The full salary range is $141,000 - $231,000 and the bonus target is 20%. The expected salary range is $150,500 - 203,600. Regional pay structure - applies to North Dakota and to Idaho, Oregon, Washington, and Utah locations outside the metro areas listed above. The full salary range is $127,000 - $208,000 and the bonus target is 20%. The expected salary range is $135,400 - $183,200. 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? 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. 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 View email address on click.appcast.io. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. #J-18808-Ljbffr