Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Columbus (OH); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading company in healthcare is seeking a Regional Director of Quality Solutions. This remote role focuses on strategic performance improvement and compliance within the Health Plan Performance team. Candidates should have extensive experience in managed care and quality assurance, with a strong background in data acquisition and leadership.

Qualifications

• 7-10 years in Managed Care and/or health plan quality required.
• Clinical experience for accreditation and compliance needed.
• RN with a quality background preferred.

Responsibilities

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

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 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 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/Abilities

• Serves as the subject matter expert for all Medicaid / Medicare / Marketplace quality and data acquisition functions to ensure compliance.
• Consults with MHI QS leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements.
• Supports development of a strategic roadmap and related tools with the assigned plans and MHI QS that enable staff and communicate the strategy and roadmap to health plan leadership.
• Liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, including sharing performance status, risks, needs, and suggested modifications to current plans to achieve performance goals.
• Direct management of QS HPP program manager. Coordination with health plan quality staff. Ensure organization with other enterprise teams within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and 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.
• Possesses strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business. Some understanding of accreditation and compliance.
• Participates in Molina national and health plan meetings, including preparation and documentation of follow-up actions.
• Coordinates reporting and packaging for leadership meetings.
• Responsible for development of materials and analysis supporting ongoing communications with the health plan. Initiates team meetings to promote collaboration and meet KPIs and timelines.
• Communicates with senior leadership about key deliverables, timelines, barriers, and escalations.
• Communicates a clear strategy with KPIs and updates in assigned areas.
• Presents summaries, key takeaways, and action steps about functional areas in meetings.
• Demonstrates ability to lead or influence cross-functional teams, remotely or in-office.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or equivalent experience.

Required Experience

At least 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 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 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.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Quality Assurance
• Industries: IT Services and IT Consulting