Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; City of Yonkers (NY); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading company is seeking a Regional Director of Quality Solutions to oversee performance improvement within the Health Plan Performance team. This remote role requires strong expertise in quality improvement, compliance, and data acquisition, with a focus on Medicaid. The ideal candidate will have extensive experience in managed care and will act as a liaison between national and local teams, ensuring compliance and performance goals are met.

Qualifications

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

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Monitor external Correction Action Plans and support activities.

Skills

Quality Improvement

Data Acquisition

Compliance

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 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, 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 all 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 requirements.
• Support the 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.
• Act as 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 and coordinate with health plan quality staff. Ensure organization with other enterprise teams within Molina.
• Bridge high-level performance measures with operational/tactical initiatives; monitor intervention effectiveness; surface data gaps; propose interventions and next steps to close performance gaps.
• Ensure interventions align with overarching strategy and execution plan.
• Monitor external Correction Action Plans and support activities within standard department scope.
• Possess strong knowledge in data acquisition processes, HEDIS, and quality performance management across all LOBs, with some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, including preparation and documentation of follow-up actions.
• Coordinate reporting and packaging for critical leadership meetings.
• Manage and develop materials and analysis supporting ongoing communication with the health plan. Initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with national and health plan Senior Leadership Teams about key deliverables, timelines, barriers, and escalations.
• Communicate clear strategies with KPIs and updates in assigned areas.
• Present summaries, key takeaways, and action steps to national and health plan meetings.
• Demonstrate ability to 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 for Accreditation, Compliance, HEDIS Interventions, Quality of Care issues, and medical record abstraction. Technical and strategy 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.

To all current Molina employees: Interested applicants should apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina 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.