Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; San Antonio (TX); 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 and ensure compliance within the Health Plan Performance team. This role requires extensive experience in managed care and quality management, with a focus on Medicaid and Medicare. The ideal candidate will bridge the gap between national strategies and local operations, ensuring that key performance indicators are met while leading cross-functional teams.

Qualifications

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

Responsibilities

• Coordinate national and local operations for quality solutions.
• Act as liaison between national QS organization and health plan leadership.
• Monitor intervention effectiveness and propose next steps.

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

Job Summary

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, including 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 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 that enable staff and communicate the strategy and roadmap to health plan leadership.
• Act as 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 and identify data gaps; propose interventions and next steps to close performance gaps.
• Ensure interventions align with overarching strategy and execution plans.
• Monitor external Correction Action Plans and support activities within the department's scope.
• Possess strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business, with some understanding of accreditation and compliance.
• Participate in Molina's national and health plan meetings, including thorough preparation and documentation of follow-up actions.
• Coordinate reporting and materials for leadership meetings.
• Manage and develop materials and analysis supporting ongoing communications with the health plan, and initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present concise summaries, key takeaways, and action steps about the functional area in meetings.
• Lead or influence cross-functional teams, including remote staff 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 needed for 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 License, Certification, Association

RN with a quality background is preferred.

To all current Molina employees: Please apply through the intranet job listing.

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

Pay Range: $97,299 - $189,732 / ANNUAL

• Actual compensation may vary 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