Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Mesa (AZ); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading healthcare organization is seeking a Regional Director of Quality Solutions to oversee performance improvement initiatives. This remote role requires extensive experience in managed care and quality management, focusing on compliance and strategic operations. The ideal candidate will possess strong leadership skills and a deep understanding of Medicaid and Medicare quality standards, ensuring that the organization meets its performance goals effectively.

Benefits

Competitive benefits and compensation package

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.
• Monitor external Correction Action Plans and support related activities.

Skills

Medicaid

Medicare

Quality Improvement

Data Acquisition

Performance Management

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

This role provides the option for remote work, ideally suited for candidates living in the Eastern Time Zone.

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 such as quality improvement (primarily Medicaid) and data capture/supplemental data submission, and 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 development of a strategic roadmap and related tools with the assigned plans and MHI QS to 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 and coordinate with health plan quality staff, ensuring organization with other enterprise teams within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and identify data gaps; propose interventions and next steps to close performance gaps.
• Ensure interventions align with overarching strategy and execution plan.
• Monitor external Correction Action Plans and support related activities within standard department scope.
• Possess strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business; some understanding of accreditation and compliance.
• Participate in Molina national and health plan meetings, including preparation and documentation of follow-up actions.
• Coordinate reporting and materials for leadership meetings.
• Manage and develop materials and analyses supporting ongoing communication with the health plan, and initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with national and health plan senior leadership about key deliverables, timelines, barriers, and escalations requiring immediate attention.
• Present concise summaries, key takeaways, and action steps about the functional area in meetings.
• Demonstrate ability to lead or influence cross-functional teams across remote and in-office locations 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 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 all current Molina employees: Interested candidates 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.

Pay Range: $97,299 - $189,732 / annually.

• Actual compensation may vary based on location, experience, education, and skills.