Executive Director, Clinical Performance & Quality (Remote)

Molina Healthcare; Northern (KY); Remote; USD 186,000 - 363,000; Full time

Benefits offered by this job

Competitive benefits

Remote-friendly environment

Job summary

Molina Healthcare seeks an executive leader responsible for enterprise clinical operations, oversight of Utilization Management, Care Management, and LTSS, with accountability for quality, financial performance, and member outcomes.

The role requires strong strategic thinking, cross-functional collaboration, and deep knowledge of regulatory requirements to drive continuous improvement across the organization.

Qualifications

• At least 12 years of managed care experience in a matrixed organization.
• At least 7 years health care management/leadership experience.
• Clinical licensure and/or certification required ONLY if mandated by state contract or regulation.
• Strong leadership, interpersonal, and problem-solving skills.
• Ability to work in a cross-functional, highly matrixed environment.

Responsibilities

• Provide executive oversight for UM, CM, and LTSS audit programs.
• Lead centralized clinical audit team for compliance and performance reporting.
• Guide clinical workforce management, staffing strategy, and productivity.
• Drive HEDIS/Stars initiatives to improve quality and outcomes.
• Oversee clinical vendor and delegated entity performance and governance.
• Collaborate with Enterprise Information Management for data and reporting.
• Travel approx. 25%.

Skills

Leadership

Strategic planning

Cross-functional collaboration

Analytical thinking

Regulatory compliance

Communication

Problem solving

Project management

Microsoft Office

Operational excellence

Education

RN licensure

CPHQ Certification

CPHM Certification

Tools

Microsoft Excel

Job description

Molina Healthcare seeks an executive leader responsible for enterprise clinical operations, oversight of Utilization Management, Care Management, and LTSS, with accountability for quality, financial performance, and member outcomes.

The role requires strong strategic thinking, cross-functional collaboration, and deep knowledge of regulatory requirements to drive continuous improvement across the organization.