Regional Director, Quality Solutions (Remote)

Lensa; Detroit (MI); Remote; USD 97,000 - 190,000; Full time

Job summary

An established industry player is seeking a Regional Director of Quality Solutions to drive strategic performance improvement in the healthcare sector. This pivotal role involves overseeing quality initiatives, ensuring compliance with Medicaid and Medicare standards, and serving as the primary liaison between national and regional teams. The ideal candidate will have extensive experience in managed care, a strong understanding of quality performance management, and the ability to lead cross-functional teams effectively. Join a forward-thinking organization committed to excellence in healthcare quality and make a significant impact on community health outcomes.

Qualifications

• 7-10 years experience in Managed Care and health plan quality.
• Strong knowledge in data acquisition processes and compliance.

Responsibilities

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

Skills

Medicaid / Medicare / Marketplace quality

Data acquisition

Quality performance management

Compliance requirements

HEDIS Interventions

Clinical experience

Strategic roadmap development

Cross-functional team leadership

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote)

Regional Director, Quality Solutions (Remote)

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Job Description

Job Summary

Regional Director 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 in, quality improvement (primarily Medicaid) and data capture/supplemental data submission and coordinating national and local operations. This person will be the liaison between the national QS organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving 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 all, Medicaid / Medicare / Marketplace quality, and data acquisition functions to ensure participants understands and meets compliance requirements.
• Consults with MHI QS leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements.
• Supports development of a strategic roadmap and related tools with the assigned plans and MHI QS that enables staff and communicates the strategy and roadmap ongoing to health plan leadership.
• Liaison between MHI QS leaders, Centers of Excellence and health plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals.
• Direct management of QS HPP program manager. Coordination with health plan quality staff. Ensure organization with other enterprise teams within Molina.
• Bridge high-level measures performance with operational/tactical initiatives; Monitor ongoing intervention effectiveness and surface any data gaps; Propose interventions and next steps to close performance gaps
• Ensure intervention aligns with overarching strategy and execution plan
• Monitor external Correction Action Plans and support activities within standard department scope
• Possesses a strong knowledge in data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions.
• Coordinate reporting and packaging needs for critical leadership meetings.
• Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines.
• Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention.
• Communicates a clear strategy with key performance indicators and updates in assigned areas.
• Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings.
• Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country.
  
  

Job Qualifications

Required Education

Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience.

Required Experience

At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction. Technical and strategy experience is needed for positions focused on interventions.

Preferred Education

Master's Degree in a related field

Preferred License, Certification, Association

RN with Quality Background is preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $97,299 - $189,732 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  IT Services and IT Consulting

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