Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Saint Petersburg (FL); 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 in Medicaid quality. This remote role requires strong leadership and expertise in quality management, data acquisition, and compliance. Candidates should have a Bachelor's degree and extensive experience in Managed Care. The position offers competitive benefits and compensation, with a pay range of $97,299 to $189,732 annually.

Qualifications

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

Responsibilities

• Oversee performance and execution for regional states within the HPP team.
• Act as liaison between national QS organization and health plan leadership.
• Monitor external Correction Action Plans and support related activities.

Skills

Quality Improvement

Data Acquisition

Compliance

Leadership

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 for regional states within the Health Plan Performance (HPP) team. Key activities include serving as the subject matter expert in quality improvement (primarily Medicaid), data capture, and coordinating national and local operations. This person acts as the liaison between the national QS organization (MHI) and health plan leadership to ensure the team meets key performance indicators and timelines. They also 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, 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 activities meet compliance standards.
• Support the development of a strategic roadmap and related tools with assigned plans and MHI QS, enabling staff and communicating 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 to ensure organizational alignment within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness; identify data gaps; propose interventions and next steps to close performance gaps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within standard department scope.
• Possess strong knowledge of 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 materials for critical leadership meetings.
• Manage and develop materials and analysis supporting 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.
• Clearly communicate strategy, KPIs, and updates in assigned areas.
• Present summaries, key takeaways, and action steps regarding functional areas in meetings.
• Demonstrate ability to lead or influence cross-functional teams, remotely or in-office across the country.

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, potential quality of care issues, and medical record abstraction. Technical and strategic experience is needed 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 interested should apply via the intranet.

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.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Quality Assurance