Regional Director, Quality Solutions (Remote)

Lensa; Columbus (GA); Remote; USD 97,000 - 190,000; Full time

Job summary

An established industry player is seeking a Regional Director of Quality Solutions to lead performance improvement initiatives within Medicaid. This pivotal role involves collaborating with various teams to ensure compliance and enhance quality standards. The ideal candidate will possess extensive experience in managed care, with a strong focus on data acquisition and quality performance management. Join a forward-thinking firm that values innovation and teamwork, where your expertise will directly impact the quality of care delivered to communities. If you're ready to take your career to the next level in a dynamic environment, this opportunity is for you.

Qualifications

• 7-10 years in Managed Care and health plan quality.
• Clinical experience for accreditation and compliance required.

Responsibilities

• Oversees performance and execution for assigned regional states.
• Acts as liaison between national QS organization and health plan leadership.

Skills

Medicaid Quality Improvement

Data Acquisition

HEDIS Knowledge

Strategic Roadmap Development

Leadership Skills

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote)

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

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 of quality improvement (primarily Medicaid) and data capture/supplemental data submission, coordinating national and local operations. This person acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure the team meets defined key performance indicators and timelines, and serves as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues.

Knowledge/Skills/Abilities

• Serves as the subject matter expert for Medicaid / Medicare / Marketplace quality and data acquisition functions to ensure compliance requirements are understood and met.
• Collaborates with MHI QS leaders, national, and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance standards.
• Supports development of a strategic roadmap and related tools with assigned plans and MHI QS, enabling staff and communicating the strategy to health plan leadership.
• Acts 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.
• Manages the QS HPP program manager and coordinates with health plan quality staff, ensuring organizational alignment with other enterprise teams within Molina.
• Bridges high-level performance measures with operational initiatives; monitors intervention effectiveness and identifies data gaps; proposes interventions and next steps to close performance gaps.
• Ensures interventions align with the overarching strategy and execution plan.
• Monitors external Correction Action Plans and supports related activities within the department's scope.
• Possesses strong knowledge in data acquisition, HEDIS, and quality performance management across all lines of business, with some understanding of accreditation and compliance.
• Participates in Molina national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinates reporting and presentation materials for leadership meetings.
• Develops materials and analyses supporting ongoing communication with the health plan, and initiates team meetings to promote collaboration and meet KPIs and timelines.
• Communicates with senior leadership regarding key deliverables, timelines, barriers, and escalations.
• Clearly articulates strategies, KPIs, and updates in assigned areas.
• Presents summaries, key insights, and action steps to national and health plan meetings.
• Demonstrates leadership or influence over cross-functional teams, including remote or in-office staff nationwide.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or related field.

Required Experience

7-10 years in Managed Care and/or health plan quality. Clinical experience required for accreditation, compliance, HEDIS interventions, quality of care issues, and medical record abstraction. Technical and strategic experience needed for intervention-focused roles.

Preferred Education

Master's Degree in a related field.

Preferred License, Certification, Association

RN with a quality background is preferred.

To all current Molina employees: Please apply through the intranet job listing.

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

Pay Range: $97,299 - $189,732 annually. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Quality Assurance
• Industries: IT Services and IT Consulting