Regional Director, Quality Solutions (Remote)

Lensa; New York (NY); 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. This remote role involves serving as a subject matter expert in Medicaid and quality management, ensuring compliance, and collaborating with cross-functional teams. The ideal candidate will possess extensive experience in managed care and quality assurance, along with strong leadership skills to drive performance goals. Join a forward-thinking organization that values innovation and excellence in healthcare delivery, and make a significant impact on quality solutions across regional health plans.

Qualifications

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

Responsibilities

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

Skills

Medicaid expertise

Medicare knowledge

Data acquisition

Quality performance management

HEDIS knowledge

Compliance standards

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)

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 and overseeing performance and execution for assigned regional states within the Health Plan Performance (HPP) team. Key activities include serving as a subject matter expert in quality improvement (primarily Medicaid), data capture/supplemental data submission, and 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 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 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 the 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 department 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 beforehand and documenting follow-up actions.
• Coordinate reporting and material preparation for leadership meetings.
• Manage and develop communication materials, analysis, and support ongoing collaboration to meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present clear summaries, key takeaways, and action steps regarding functional areas.
• 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 for accreditation, compliance, HEDIS interventions, and medical record abstraction; strategic and technical experience for intervention focus.

Preferred Education

Master's Degree in a related field.

Preferred License, Certification, Association

RN with a quality background is preferred.

Interested Molina employees should apply via the intranet. Molina offers a competitive benefits package. Molina Healthcare 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.