Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Las Cruces (NM); 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 and compliance in health plans. This remote role requires extensive experience in managed care, quality assurance, and data management. Candidates should hold a Bachelor's degree in a related field, with a strong background in Medicaid and HEDIS. The position offers competitive compensation and the opportunity to influence quality strategies across multiple regions.

Qualifications

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

Responsibilities

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

Skills

Quality Improvement

Data Acquisition

Compliance

Medicaid Knowledge

HEDIS

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 across 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/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 key performance indicators 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 to ensure ongoing compliance.
• Support the development of a strategic roadmap and tools with assigned plans and MHI QS to enable staff and communicate strategies 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 and coordinate with health plan quality staff, ensuring organizational alignment within Molina.
• 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 within department scope.
• Possess strong knowledge in data acquisition, HEDIS, and quality performance management across lines of business, with some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, preparing materials and documenting follow-up actions.
• Coordinate reporting for leadership meetings.
• Develop materials and analysis to support communication with the health plan, promoting collaboration to meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present summaries, key takeaways, and action steps in meetings.
• Lead or influence cross-functional teams in remote or in-office locations nationwide.

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, HEDIS interventions, and medical record abstraction. Technical and strategic 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: Apply through the intranet job listing.

Molina Healthcare offers competitive benefits and compensation. We are 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.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting