Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

Job summary

An established industry player in healthcare is seeking a Regional Director of Quality Solutions to drive strategic performance improvement across regional states. This remote position is ideal for candidates in the Eastern Time Zone and involves overseeing quality initiatives, ensuring compliance with Medicaid and Medicare standards, and collaborating with cross-functional teams. The role requires a strong background in managed care, quality performance management, and data acquisition, making it a pivotal position for someone looking to make a significant impact in healthcare quality. Join a dynamic team and help shape the future of health plan performance!

Qualifications

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

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Monitor intervention effectiveness and propose improvements.

Skills

Medicaid knowledge

Quality improvement

Data acquisition

HEDIS

Compliance knowledge

Performance management

Clinical experience

Strategic planning

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in 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 contributing to 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, and supplemental data submission, coordinating national and local operations. This person will liaise between the national QS organization (MHI) and health plan leadership to ensure key performance indicators and timelines are met, and serve 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.
• Support development of a strategic roadmap and related tools with assigned plans and MHI QS, enabling staff and communicating strategy to health plan leadership.
• Act as liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, sharing performance status, risks, needs, and suggested modifications.
• 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 and identify data gaps; propose interventions to close performance gaps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within department scope.
• Possess strong knowledge of data acquisition, HEDIS, and quality performance management across lines of business, with some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinate reporting and packaging for leadership meetings.
• Manage and develop materials and analyses supporting communication with the health plan, promoting collaboration and meeting KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries and action steps regarding functional areas.
• Lead or influence cross-functional teams, remotely or in-office, 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 needed for 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 Certifications

RN with a quality background is preferred.

To all current Molina employees: Apply through the intranet job listing.

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. Actual compensation may vary 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