Regional Director, Quality Solutions (Remote)

Lensa; Milwaukee (WI); Remote; USD 97,000 - 190,000; Full time

Job summary

An established industry player is seeking a Regional Director of Quality Solutions to lead strategic performance improvement initiatives across regional health plans. This role involves acting as the subject matter expert in Medicaid and Medicare quality, ensuring compliance, and collaborating with cross-functional teams to meet key performance indicators. The ideal candidate will possess strong leadership capabilities, extensive experience in managed care, and a passion for quality improvement. Join a dynamic team and make a significant impact in the healthcare sector while enjoying competitive compensation and benefits.

Qualifications

• 7-10 years in Managed Care and health plan quality.
• Clinical experience relevant to Accreditation and Compliance.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as the liaison between national QS organization and health plan leadership.
• Manage QS HPP program manager and coordinate with health plan quality staff.

Skills

Medicaid knowledge

Medicare knowledge

Quality performance management

Data acquisition processes

HEDIS interventions

Communication skills

Leadership

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a 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, and acting as the liaison between the national QS organization (MHI) and health plan leadership to ensure that the team meets key performance indicators and timelines. This role also involves 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, ensuring 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 alignment with enterprise teams 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 national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinate reporting and materials for leadership meetings.
• Manage and develop communication materials, analyses, and promote team collaboration to meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalations.
• Present concise summaries, key takeaways, and action steps 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 relevant to Accreditation, Compliance, HEDIS interventions, Quality of Care issues, and medical record abstraction. Technical and strategic experience 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 apply, current Molina employees should use the intranet job listing. Molina offers competitive benefits. Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $97,299 - $189,732 annually. Actual compensation varies 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