Regional Director, Quality Solutions (Remote)

Lensa; City of Albany (NY); Remote; USD 97,000 - 228,000; Full time

Job summary

An established industry player is seeking a Regional Director of Quality Solutions to lead performance improvement initiatives in the healthcare sector. This role involves acting as a subject matter expert in quality improvement, particularly in Medicaid, while ensuring compliance with regulatory requirements. You will collaborate with cross-functional teams and senior leadership to drive strategic goals and monitor performance metrics. If you have a strong background in managed care and are passionate about quality assurance, this opportunity offers a chance to make a significant impact in a dynamic environment.

Qualifications

• 7-10 years in Managed Care and health plan quality.
• Clinical experience essential for Accreditation and Compliance roles.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as a liaison between national QS organization and health plan leadership.
• Monitor intervention effectiveness and propose corrective actions.

Skills

Medicaid Compliance

Data Acquisition

Quality Performance Management

HEDIS Knowledge

Cross-functional Team Leadership

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in related field

Job description

Regional Director, Quality Solutions (Remote)

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Job Description

Job Summary

The Regional Director of Quality Solutions (QS) is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states within the Health Plan Performance (HPP) team. Key activities include serving as the subject matter expert in all functional areas related to quality improvement (primarily Medicaid) and data capture/supplemental data submission, coordinating national and local operations. This person will act as the liaison between the national QS organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines, serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues.

Knowledge/Skills/Abilities

• Serve as the subject matter expert for Medicaid, Medicare, and Marketplace quality and data acquisition functions to ensure compliance requirements are understood and met.
• Consult with MHI QS leaders, national, and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance standards.
• Support the development of a strategic roadmap and related tools with assigned plans and MHI QS, enabling staff and communicating the strategy to health plan leadership.
• Act as a liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, sharing performance status, risks, needs, and suggested modifications to achieve performance goals.
• Manage the QS HPP program manager and coordinate with health plan quality staff, ensuring organizational alignment within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness, identify data gaps, and propose corrective actions.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within standard scope.
• Possess strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business, with some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, preparing materials and documenting follow-up actions.
• Coordinate reporting and preparation for leadership meetings.
• Manage and develop communication materials and analysis to support ongoing interactions with the health plan, promoting team collaboration to meet KPIs and timelines.
• Communicate effectively with senior leadership regarding key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries and actionable insights about the functional area in meetings.
• Lead or influence cross-functional teams across remote and in-office locations nationwide.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or equivalent experience.

Required Experience

7-10 years in Managed Care and/or health plan quality. Clinical experience is essential for roles focused on Accreditation, Compliance, HEDIS interventions, and medical record abstraction. Technical and strategic experience is needed for intervention-focused roles.

Preferred Education

Master's Degree in a related field.

Preferred License, Certification, Association

RN with a background in Quality is preferred.

Interested Molina employees should apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $97,299 - $227,679 annually. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Senior Level: Director
• Employment Type: Full-time
• Job Function: Quality Assurance
• Industries: IT Services and IT Consulting