Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Houston (TX); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading company in healthcare is seeking a Regional Director of Quality Solutions to oversee performance improvement in Medicaid quality. This role, ideally for candidates in the Eastern Time Zone, involves strategic oversight, compliance, and collaboration with health plan leadership. The ideal candidate will have extensive experience in managed care and quality assurance, ensuring compliance with healthcare standards while leading cross-functional teams.

Qualifications

• 7-10 years of experience in Managed Care and/or health plan quality.
• Clinical experience needed for roles focused on Accreditation, Compliance, HEDIS.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Manage QS HPP program manager and coordinate with health plan quality staff.

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.

The 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, as well as 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 will 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 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 standards.
• Support the development of a strategic roadmap and related tools with assigned plans and MHI QS that enable staff and communicate the strategy to health plan leadership.
• Act as a 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 directly and coordinate with health plan quality staff, ensuring organizational alignment within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness; identify data gaps; propose interventions and next steps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within the department's scope.
• Possess strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business. Some understanding of accreditation and compliance is preferred.
• Participate in Molina national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinate reporting and materials for leadership meetings.
• Manage and develop materials and analysis supporting communications with the health plan, and initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership teams about key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries, key takeaways, and action steps about the functional area in meetings.
• Demonstrate the ability to lead or influence cross-functional teams, including remote staff across the country.

Job Qualifications

Required Education

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

Required Experience

At least 7-10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for roles focused on Accreditation, Compliance, HEDIS Interventions, and medical record abstraction. Technical and strategy experience is required for intervention-focused roles.

Preferred Education

Master's Degree in a related field.

Preferred License, Certification, Association

RN with a background in Quality is preferred.

To all current Molina employees: Please apply through the intranet job listing if interested.

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.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting