Director, Health Plan Quality & Performance

Molina Healthcare; Town of Texas (WI); Hybrid; USD 97,000 - 190,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare seeks an senior leader to direct quality management and performance improvement initiatives across health plans. You will drive NCQA accreditation readiness, HEDIS reporting, and policy development while coordinating with national analytics and strategy teams.

Responsibilities include leading teams, managing audits, and presenting quality performance to senior leadership. Strong data analysis, regulatory knowledge, and effective communication are essential.

Qualifications

• 8+ years in health care with 5+ years in health plan quality improvement.
• 3+ years of management/leadership experience.
• Advanced knowledge of HEDIS/NCQA.
• CAHPS improvement experience.
• HEDIS reporting/collection experience.
• Experience with Medicaid/Medicare/Marketplace programs.
• State quality improvement experience.
• Strong business writing experience.
• Strategic-thinking skills.
• Data analysis, manipulation, interpretation, reporting and data-driven decisions.
• Critical-thinking and analytical skills.
• Attention to detail and organization.
• Ability to lead process improvements and drive change.
• Ability to work independently in a fast-paced environment.
• Cross-functional matrixed organization experience.
• Project management experience.
• Excellent verbal and written communication.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Directs team implementing key quality program management strategies, audits and NCQA/state regulatory requirements.
• Oversees quality program management and performance activities to meet NCQA/state requirements.
• Represents senior leadership at national/regional meetings and oversees performance improvement projects.
• Collaborates with analytics and strategy teams to evaluate QPMP activities.
• Maintains policies, procedures, committee structures, and reporting deliverables.
• Prepares clear reports incorporating member/provider feedback and CI tools.
• Maintains policy addendums reflecting state and NCQA requirements.
• Manages training and development of quality staff to regulatory standards.
• Ensures staff are versed in quality program requirements and contract obligations.
• Implements tracking and trending of KPIs, process reviews, and gap analyses.
• Applies PDSA cycles to drive individual and organizational improvements.
• Hires, trains, and manages team; ensures accountability for goals.

Skills

Leadership

Data analysis

Strategic thinking

Project management

Communication

Problem solving

Attention to detail

Cross-functional collaboration

Business writing

Excel

Tools

Microsoft Office

Data systems proficiency

Job description

Molina Healthcare seeks an senior leader to direct quality management and performance improvement initiatives across health plans. You will drive NCQA accreditation readiness, HEDIS reporting, and policy development while coordinating with national analytics and strategy teams.

Responsibilities include leading teams, managing audits, and presenting quality performance to senior leadership. Strong data analysis, regulatory knowledge, and effective communication are essential.