Regional Director, Quality Solutions (Remote Eastern Time Zone)

Molina Healthcare; Long Beach (CA); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Regional Director of Quality Solutions to enhance performance improvement across designated states. This pivotal role involves acting as the subject matter expert in Medicaid quality improvement and data management, while coordinating national and local operations. You will engage with cross-functional teams to ensure compliance with key performance indicators and timelines, and lead initiatives that bridge operational strategies with high-level performance measures. If you thrive in a dynamic environment and are passionate about quality in healthcare, this opportunity is for you.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

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

Responsibilities

• Oversee performance and execution for designated regional states.
• Act as liaison between national QS organization and health plan leadership.
• Monitor intervention effectiveness and propose corrective actions.

Skills

Medicaid expertise

Quality improvement

Data acquisition

HEDIS knowledge

Compliance understanding

Cross-functional team leadership

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

JOB DESCRIPTION

Job Summary

The Regional Director of Quality Solutions (QS) is responsible for contributing to strategic performance improvement and overseeing performance and execution for designated 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 role acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure achievement of key performance indicators and timelines, serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues.

Knowledge, Skills, and Abilities

• Serve as the subject matter expert for Medicaid, Medicare, and 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 to enable staff and communicate strategies effectively 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 with other enterprise teams within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness, identify data gaps, and propose corrective actions.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within standard departmental scope.
• Possess strong knowledge in data acquisition, HEDIS, and quality performance management across all lines of business, 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 packaging for leadership meetings.
• Manage and develop materials and analyses supporting ongoing communications with the health plan, initiating team meetings to promote collaboration and meet KPIs.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalations requiring immediate attention.
• Present concise summaries, key insights, and action steps in meetings.
• Lead or influence cross-functional teams, including remote or in-office staff across the country.

Job Qualifications

Required Education

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

Required Experience

7-10 years in Managed Care and/or health plan quality. Clinical experience is necessary for roles focused on accreditation, compliance, HEDIS interventions, quality of care issues, and medical record abstraction. Technical and strategic experience is needed for positions focused on interventions.

Preferred Education

Master's Degree in a related field.

Preferred Licenses, Certifications, Associations

RN with a background in Quality is preferred.

To all current Molina employees: Interested applicants should apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.