Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

Job summary

A leading healthcare organization is seeking a Regional Director of Quality Solutions, responsible for overseeing quality improvement initiatives across regional states. This remote role requires extensive experience in managed care and quality management, ensuring compliance and effective performance metrics are met. The ideal candidate will possess strong leadership skills and a deep understanding of Medicaid and Medicare quality standards.

Benefits

Competitive benefits and compensation package

Qualifications

• 7-10 years in Managed Care and/or health plan quality required.
• Clinical experience needed for accreditation and compliance.
• Technical and strategic experience for intervention-focused roles.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Serve as subject matter expert in quality improvement.
• Coordinate national and local operations.

Skills

Medicaid knowledge

Quality performance management

Data acquisition

HEDIS

Leadership

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote Eastern Time Zone)

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Job Description

Job Summary

This role provides the option for remote work, ideally suited for candidates living in the Eastern Time Zone.

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 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, 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 Medicaid, Medicare, Marketplace quality, and data acquisition functions to ensure compliance requirements are understood and met.
• 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, enabling staff and communicating the strategy and roadmap to health plan leadership.
• Acts as the 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 within Molina.
• Bridges high-level performance measures with operational initiatives; monitors intervention effectiveness, identifies data gaps, and proposes interventions to close performance gaps.
• Ensures interventions align with overarching strategies and execution plans.
• 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 materials for leadership meetings.
• Develops materials and analysis to support ongoing communications with the health plan, and initiates team meetings to promote collaboration and meet KPIs.
• Communicates with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Presents summaries, key takeaways, and action steps regarding functional areas.
• Demonstrates ability to lead or influence cross-functional teams in remote or in-office locations across the country.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or related field, 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 needed 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: Interested applicants should 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 based on location, experience, education, and skills.