Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Columbus (GA); 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 in Medicaid quality. This remote role requires strong leadership and expertise in quality management and data acquisition. The successful candidate will liaise between national and local teams to ensure compliance and performance goals are met.

Qualifications

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

Responsibilities

• Oversee performance and execution for assigned regional states.
• Serve as the primary contact for cross-functional teams.
• Monitor intervention effectiveness and identify data gaps.

Skills

Quality Improvement

Data Acquisition

Compliance

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, 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 understanding and 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, enabling staff and communicating the strategy 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 achieve performance goals.
• Manages the QS HPP program manager and coordinates with health plan quality staff, ensuring organizational alignment within Molina.
• Bridges high-level performance measures with operational initiatives; monitors intervention effectiveness and identifies data gaps; proposes interventions to close performance gaps.
• Ensures interventions align with overarching strategies and execution plans.
• Monitors external Correction Action Plans and supports related activities within standard scope.
• Possesses strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business, with some understanding of accreditation and compliance.
• Participates in Molina national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinates reporting and material preparation for leadership meetings.
• Develops materials and analyses supporting communication with the health plan, promoting collaboration and meeting KPIs and timelines.
• Communicates with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Provides clear strategy updates with KPIs and key performance metrics.
• Presents summaries, key takeaways, and action steps to national and health plan meetings.
• Leads or influences cross-functional teams, including remote staff across locations.

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, with clinical experience for accreditation and compliance roles, and technical/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: Please 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