Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Roswell (NM); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading company in healthcare seeks a Regional Director of Quality Solutions to oversee performance improvement and ensure compliance across Medicaid and Medicare quality initiatives. This remote role requires strong leadership and strategic planning skills to bridge operational initiatives and high-level performance measures, ensuring alignment with health plan goals. Ideal candidates will have extensive experience in managed care and quality management, with a focus on data acquisition and compliance.

Benefits

Competitive Benefits

Qualifications

• 7-10 years in Managed Care and/or health plan quality.
• Clinical experience for accreditation, compliance, and medical record abstraction.

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

Quality Management

Data Acquisition

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)

Be among the first 25 applicants three days ago. Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

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 all functional areas related to quality improvement (primarily Medicaid) and data submission, coordinating national and local operations. This person will act as the liaison between the national QS organization (MHI) and health plan leadership to ensure key performance indicators and timelines are met, and will serve 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.
• Consult with MHI QS leaders and health plan leadership to facilitate understanding of requirements and staff training.
• Support development of a strategic roadmap and tools with assigned plans and MHI QS, and communicate the strategy to health plan leadership.
• Act as liaison between MHI QS leaders, Centers of Excellence, and health plan leadership, sharing performance status, risks, and needs.
• Manage the QS HPP program manager and coordinate with health plan quality staff, ensuring organizational alignment.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and data gaps; propose actions to close performance gaps.
• Ensure interventions align with strategy and execution plans.
• Monitor external Correction Action Plans and support related activities.
• Possess strong knowledge in data acquisition, HEDIS, and quality 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 and develop communication materials supporting ongoing activities.
• Lead or influence cross-functional teams, including remote staff, to meet KPIs and timelines.

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, with clinical experience for accreditation, compliance, and medical record abstraction roles. 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.

Current Molina employees should apply through the intranet.

Molina Healthcare offers competitive benefits. We are 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.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Quality Assurance
• Industries: IT Services and IT Consulting