Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Mesa (AZ); 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 plan quality. The role involves strategic planning, data management, and cross-functional collaboration to meet performance goals. Candidates should have extensive experience in managed care and quality improvement, with a strong educational background in healthcare administration.

Qualifications

• 7-10 years in Managed Care and/or health plan quality.
• Clinical experience related to Accreditation, Compliance, HEDIS interventions.

Responsibilities

• Contribute to strategic performance improvement for regional states.
• Serve as subject matter expert in quality improvement and data capture.
• Coordinate national and local operations and act as liaison.

Skills

Leadership

Data Acquisition

Quality Improvement

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote Eastern Time Zone)

This position offers the flexibility of remote work, ideally for candidates residing 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 designated regional states within the Health Plan Performance (HPP) team. Key responsibilities include serving as a subject matter expert in all functional areas related to quality improvement (primarily Medicaid), data capture, and supplemental data submission. The role also involves coordinating national and local operations, acting as a liaison between the national QS organization (MHI) and health plan leadership to ensure key performance indicators and deadlines are met, and serving as the primary contact 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 and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing compliance.
• Support the development of a strategic roadmap and related 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 collaboration 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 activities within the department's scope.
• Possess strong knowledge of data acquisition processes, 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 materials for leadership meetings.
• Develop and manage materials and analysis supporting communication with the health plan, fostering team collaboration to meet KPIs and deadlines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present summaries, key takeaways, and action steps effectively to national and health plan meetings.
• Demonstrate leadership or influence across cross-functional teams, including remote or in-office staff nationwide.

Job Qualifications

Required Education

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

Required Experience

7-10 years in Managed Care and/or health plan quality. Clinical experience related to Accreditation, Compliance, HEDIS interventions, Quality of Care issues, and medical record abstraction. Technical and strategic experience for intervention-focused roles.

Preferred Education

Master's Degree in a related field.

Preferred Licenses/Certifications

RN with a background in Quality is preferred.

To apply, current Molina employees should use the intranet job listing. Molina offers competitive benefits. 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.