Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Houston (TX); 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 healthcare. This remote role requires expertise in Medicaid quality, data acquisition, and compliance. The successful candidate will manage teams, liaise with leadership, and ensure adherence to performance goals. Ideal for those with extensive experience in managed care and quality assurance, this position offers competitive benefits and a salary range reflecting the candidate's skills and location.

Qualifications

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

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 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 for assigned regional states within the Health Plan Performance (HPP) team. Key activities include serving as the subject matter expert in quality improvement (primarily Medicaid) and data capture/supplemental data submission, and coordinating national and local operations. This person acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure the team meets key performance indicators and timelines, 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 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 development of a strategic roadmap and related tools with assigned plans and MHI QS to enable staff and communicate 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 meet performance goals.
• 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; 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 activities within standard scope.
• Possess strong knowledge in data acquisition, HEDIS, and quality performance management across all LOBs, 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 materials for critical leadership meetings.
• Manage and develop communication materials and analysis supporting ongoing interactions with the health plan.
• Initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership regarding deliverables, timelines, barriers, and escalations.
• Present summaries, key takeaways, and action steps in meetings.
• Lead or influence cross-functional teams, including remote or in-office staff 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 accreditation, compliance, HEDIS interventions, and medical record abstraction. Technical and strategic experience is required 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 and is 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.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting