Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Aurora (IL); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading healthcare organization is seeking a Regional Director of Quality Solutions to oversee performance improvement and ensure compliance within the Health Plan Performance team. This remote role is ideal for candidates in the Eastern Time Zone. The director will serve as a subject matter expert, facilitate training, and manage cross-functional teams to meet strategic goals. Candidates should possess extensive experience in managed care quality and a relevant degree.

Qualifications

• 7-10 years in Managed Care and/or health plan quality.
• Clinical experience needed for Accreditation, Compliance, HEDIS.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Manage the QS HPP program manager directly.

Skills

Quality Improvement

Data Acquisition

Compliance

Leadership

Communication

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 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 all functional areas related to quality improvement (primarily Medicaid), data capture, and supplemental data submission, as well as coordinating national and local operations. This person will act as the liaison between the national QS organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines. They will also 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 all Medicaid, Medicare, and 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 development of a strategic roadmap and related tools with assigned plans and MHI QS to enable staff and communicate 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 directly. Coordinate with health plan quality staff and ensure organizational alignment with other enterprise teams 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 strategy and execution plans.
• Monitor external Correction Action Plans and support activities within the standard department 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 also required.
• Participate in Molina national and health plan meetings, including preparation, communication, and documentation of follow-up actions.
• Coordinate reporting and packaging for critical leadership meetings.
• Manage and develop materials and analysis to support ongoing communication with the health plan. Lead team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership teams about key deliverables, timelines, barriers, and escalation needs.
• Clearly articulate strategies, KPIs, and updates in assigned areas.
• Present concise summaries, key takeaways, and action steps about functional areas in meetings.
• Demonstrate ability to 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 positions focused on 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 Quality background is preferred.

Current Molina employees interested in applying should do so via 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 - $189,732 / ANNUAL

• Actual 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