Forecasts of heavy precipitation delivered by atmospheric rivers (ARs) are becoming increasingly important for both flood control and water supply management in reservoirs across California. This study examines the hypothesis that medium-range forecasts of heavy precipitation at the basin scale exhibit recurrent spatial biases that are driven by mesoscale and synoptic-scale features of associated AR events. This hypothesis is tested for heavy precipitation events in the Sacramento River basin using 36 years of NCEP medium-range reforecasts from 1984 to 2019. For each event we cluster precipitation forecast error across western North America for lead times ranging from 1 to 15 days. Integrated vapor transport (IVT), 500-hPa geopotential heights, and landfall characteristics of ARs are composited across clusters and lead times to diagnose the causes of precipitation forecast biases. We investigate the temporal evolution of forecast error to characterize its persistence across lead times, and explore the accuracy of forecasted IVT anomalies across different domains of the North American west coast during heavy precipitation events in the Sacramento basin. Our results identify recurrent spatial patterns of precipitation forecast error consistent with errors of forecasted synoptic-scale features, especially at long (5–15 days) leads. Moreover, we find evidence that forecasts of AR landfalls well outside of the latitudinal bounds of the Sacramento basin precede heavy precipitation events within the basin. These results suggest the potential for using medium-range forecasts of large-scale climate features across the Pacific–North American sector, rather than just local forecasts of basin-scale precipitation, when designing forecast-informed reservoir operations.