Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

Job summary

A leading company in healthcare solutions is seeking a Regional Director of Quality Solutions. This role involves overseeing quality improvement initiatives, ensuring compliance with performance standards, and acting as a liaison between national and local teams. Candidates should have extensive experience in managed care and a strong educational background in healthcare administration.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• 7-10 years in Managed Care and/or health plan quality.
• Clinical experience for roles focused on 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

Medicare

Quality Performance Management

Data Acquisition

HEDIS

Compliance

Strategic Planning

Education

Bachelor’s Degree in Healthcare Administration

Master’s Degree in a related field

Job description

Job Description

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 related to 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, and serve as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues.

Knowledge, Skills, and Abilities

• Serve as the subject matter expert for 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 the 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 to achieve performance goals.
• Manage the QS HPP program manager and coordinate with health plan quality staff, ensuring organizational alignment with other enterprise teams 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 strategy and execution plan.
• Monitor external Correction Action Plans and support related activities within standard department scope.
• Possess strong knowledge of data acquisition processes, HEDIS, and quality performance management across all 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 critical leadership meetings.
• Manage and develop materials and analyses supporting ongoing communications with the health plan, and initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership teams regarding key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries, key takeaways, and action steps about the functional area in meetings.
• Demonstrate ability to lead or influence cross-functional teams with staff 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 and/or health plan quality. Clinical experience is needed for roles focused on accreditation, compliance, HEDIS interventions, quality of care issues, and medical record abstraction. Technical and strategic experience is necessary for intervention-focused roles.

Preferred Education

Master’s Degree in a related field.

Preferred License, Certification, and Association

RN with a quality background is preferred.

To all current Molina employees: Interested candidates 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 annually. Actual compensation may vary based on location, experience, education, and skills.