Director, Quality Improvement & Compliance

Molina Healthcare; Detroit (MI); Remote; USD 120,000 - 180,000; Full time

Job summary

Molina Healthcare seeks an experienced senior leader to drive quality improvement programs and NCQA accreditation efforts across health plans. You will guide KPI data collection, reporting, and cross-functional QA initiatives to improve member care and compliance.

The role requires strong leadership, strategic thinking, and deep knowledge of HEDIS and CAHPS measures, with experience in Medicaid/Medicare environments. Collaborative communication with senior leaders is essential.

Qualifications

• At least 8 years in health care with 5+ years in quality improvement/compliance.
• At least 3 years management/leadership experience.
• Deep knowledge of quality discipline, metrics and performance standards.
• Advanced knowledge of HEDIS/NCQA including NCQA accreditation experience.
• CAHPS, Medicare Stars, and Medicaid/Medicare/Marketplace familiarity.

Responsibilities

• Lead quality programs and initiatives across QI functional areas, including KPI data collection and reporting.
• Advise senior leaders on quality strategies and initiatives.
• Collaborate with corporate functions and state health plans to implement QI activities.
• Monitor and communicate gaps in QI implementation and drive remediation.
• Oversee NCQA accreditation surveys and federal/state QI compliance activities.
• Provide training and support to quality team members.

Skills

QI leadership

HEDIS/NCQA

Data analysis

Strategic thinking

Communication

Education

RN license

CPHQ/CHCA (preferred)

Tools

Excel

Quality software

Job description

Molina Healthcare seeks an experienced senior leader to drive quality improvement programs and NCQA accreditation efforts across health plans. You will guide KPI data collection, reporting, and cross-functional QA initiatives to improve member care and compliance.

The role requires strong leadership, strategic thinking, and deep knowledge of HEDIS and CAHPS measures, with experience in Medicaid/Medicare environments. Collaborative communication with senior leaders is essential.