Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Sioux City (IA); Remote; USD 97,000 - 190,000; Full time

Job summary

A leading company in the healthcare sector is seeking a Regional Director of Quality Solutions to oversee quality improvement initiatives across regional states. This remote role requires extensive experience in managed care and a strong understanding of compliance and data acquisition. The ideal candidate will serve as a liaison between national and local teams, ensuring that performance goals are met while leading cross-functional teams. Competitive compensation and benefits are offered.

Qualifications

• 7-10 years in Managed Care and/or health plan quality.
• Clinical experience relevant to accreditation and compliance.
• Technical and strategic experience for intervention-focused roles.

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Monitor intervention effectiveness and propose next steps.

Skills

Quality Improvement

Data Acquisition

Compliance

HEDIS

Managed Care

Education

Bachelor's Degree in Healthcare Administration

Master's Degree in a related field

Job description

Regional Director, Quality Solutions (Remote Eastern Time Zone)

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

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 related to quality improvement (primarily Medicaid) and data capture/supplemental data submission, coordinating national and local operations. This person will be 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 all 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, enabling staff and communicating 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, ensuring organization with other enterprise teams 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 strategy and execution plans.
• Monitor external Correction Action Plans and support activities within standard department scope.
• Possess strong knowledge in 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, including preparation and documentation of follow-up actions.
• Coordinate reporting and materials for leadership meetings.
• Manage and develop materials and analysis supporting ongoing communication with the health plan. Initiate team meetings to promote collaboration and meet KPIs and timelines.
• Communicate with national and health plan senior leadership regarding deliverables, timelines, barriers, and escalations.
• Present concise summaries and action steps about the functional area in meetings.
• Lead or influence cross-functional teams with staff in remote or 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 relevant to accreditation, compliance, HEDIS interventions, 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 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.

Senioriy Level

• Director

Employment Type

• Full-time

Job Function

• Quality Assurance

Industries

• IT Services and IT Consulting