Regional Director, Quality Solutions (Remote)

Lensa; Village of North Syracuse, City of Syracuse (NY, 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 within the Health Plan Performance team. This pivotal role involves serving as a subject matter expert in Medicaid, overseeing compliance, and coordinating operations across regional states. The ideal candidate will have extensive experience in managed care, quality assurance, and data management, ensuring the organization meets key performance indicators. Join a dynamic team dedicated to enhancing healthcare quality and making a significant impact in the industry.

Qualifications

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

Responsibilities

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

Skills

Medicaid Compliance

Quality Improvement

Data Acquisition

HEDIS

Leadership

Strategic Planning

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 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 acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure the team meets 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

• Serve as the subject matter expert for Medicaid, Medicare, 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 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 recommended 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; propose interventions and next steps to close performance gaps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within the department's scope.
• Possess strong knowledge of data acquisition processes, HEDIS, and quality performance management across all lines of business. Some understanding of accreditation and compliance is preferred.
• Participate in Molina’s national and health plan meetings, including preparation and documentation of follow-up actions.
• Coordinate reporting and packaging for critical leadership meetings.
• Develop materials and analysis to support ongoing communications with the health plan, and initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries, key takeaways, and action steps in meetings.
• Lead or influence cross-functional teams, including remote or in-office staff across the country.

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 needed for accreditation, compliance, HEDIS interventions, quality of care issues, and medical record abstraction. Technical and strategic experience is necessary 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.

To all current Molina employees: 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 / ANNUAL

• Actual compensation may vary based on location, experience, education, and skill level.

Additional Details

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