Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

Job summary

An established industry player is on the lookout for a Regional Director of Quality Solutions to lead performance improvement initiatives within the Health Plan Performance team. This pivotal role involves acting as a subject matter expert in Medicaid quality, ensuring compliance, and coordinating operations across regional states. Candidates will leverage their extensive experience in managed care to bridge high-level performance measures with operational initiatives, while leading cross-functional teams to meet key performance indicators. This is a fantastic opportunity to make a significant impact in a forward-thinking organization dedicated to quality healthcare.

Qualifications

• 7-10 years in Managed Care or health plan quality.
• Experience in clinical accreditation, compliance, and medical record abstraction.

Responsibilities

• Oversee performance and execution in regional states within the HPP team.
• Act as a liaison between national QS organization and health plan leadership.

Skills

Medicaid Quality Improvement

Data Acquisition

HEDIS Knowledge

Performance Management

Strategic Roadmap Development

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

This role offers remote work, ideally for candidates in the Eastern Time Zone.

The Regional Director of Quality Solutions (QS) is responsible for contributing to strategic performance improvement and overseeing performance and execution in regional states within the Health Plan Performance (HPP) team. Key activities include serving as a subject matter expert in quality improvement (primarily Medicaid), data capture, and coordinating national and local operations. This person acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure KPIs and timelines are met, and serves as the primary contact for cross-functional teams and senior leadership within Molina to address critical issues.

Knowledge/Skills/Abilities

• Serve as the subject matter expert for Medicaid/Medicare/Marketplace quality and data acquisition functions, ensuring compliance requirements are understood and met.
• Consult with MHI QS leaders and health plan leadership to facilitate understanding of requirements and staff training.
• Support the development of strategic roadmaps and tools with plans and MHI QS to enable staff and communicate strategies to leadership.
• Act as liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, sharing performance status, risks, and needs.
• Manage the QS HPP program manager and coordinate with health plan quality staff to ensure organizational alignment.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and identify data gaps; propose interventions to close gaps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities.
• Possess strong knowledge of data acquisition, HEDIS, and quality performance management across LOBs, with some understanding of accreditation and compliance.
• Participate in national and health plan meetings, preparing materials and documenting follow-up actions.
• Coordinate reporting for leadership meetings and develop materials supporting ongoing communication.
• Lead or influence cross-functional teams, including remote staff, to meet KPIs and timelines.

Job Qualifications

Required Education

Bachelor's Degree in Healthcare Administration, Public Health, or related field.

Required Experience

7-10 years in Managed Care or health plan quality, with clinical experience for accreditation, compliance, and medical record abstraction roles. 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 apply, current Molina employees should use the intranet job listing. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $97,299 - $189,732 annually. Actual compensation varies 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