Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

Job summary

A leading healthcare company seeks a Regional Director of Quality Solutions to oversee performance improvement in Medicaid quality. This remote role requires strong expertise in quality assurance and compliance, with a focus on strategic operations and team collaboration. The ideal candidate will manage cross-functional teams and liaise with leadership to meet KPIs effectively.

Qualifications

• 7-10 years in Managed Care or health plan quality.
• Clinical experience for accreditation, compliance, and HEDIS interventions.

Responsibilities

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

Skills

Quality Improvement

Data Acquisition

Compliance

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 offers remote work, ideally for candidates in the Eastern Time Zone.

The Regional Director of Quality Solutions (QS) is responsible for strategic performance improvement and overseeing performance and execution in 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, and supplemental data submission, as well as coordinating national and local operations. The person will liaise between the national QS organization (MHI) and health plan leadership to ensure KPIs and timelines are met, acting as the primary contact and escalation point for cross-functional teams and senior leadership within Molina.

Knowledge/Skills/Abilities

• Serve as the subject matter expert for Medicaid, Medicare, Marketplace quality, and data acquisition functions to ensure compliance.
• Consult with MHI QS leaders and health plan leadership to facilitate understanding of requirements and staff training to meet compliance.
• Support the development of strategic roadmaps and tools with plans and MHI QS, communicating ongoing strategies to health plan leadership.
• Act as liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, sharing performance status, risks, and suggested modifications.
• Manage the QS HPP program manager; coordinate with health plan quality staff and ensure collaboration with other enterprise teams within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and identify data gaps; propose corrective actions.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support departmental activities.
• Possess strong knowledge in data acquisition, HEDIS, and quality performance management across lines of business, with some understanding of accreditation and compliance.
• Participate in national and health plan meetings, preparing materials and documenting follow-up actions.
• Coordinate reporting for leadership meetings.
• Develop materials and analyses to support communication with the health plan, promoting team collaboration to meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, and issues requiring escalation.
• Present summaries and action steps clearly in meetings.
• Lead or influence cross-functional teams in remote or in-office locations nationwide.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or related field.

Required Experience

7-10 years in Managed Care or health plan quality, with clinical experience for accreditation, compliance, HEDIS interventions, 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.

Current Molina employees should apply through the intranet.

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

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

• Compensation may vary based on location, experience, education, and skills.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting