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 is seeking a Regional Director of Quality Solutions to oversee performance improvement in health plan quality. This remote role requires expertise in Medicaid quality management and strong leadership skills. The ideal candidate will manage cross-functional teams and ensure compliance with performance indicators. Join a dynamic team dedicated to enhancing healthcare quality and making a significant impact in the field.

Qualifications

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

Responsibilities

• Serve as subject matter expert in quality improvement and data capture.
• Manage QS HPP program and coordinate with health plan quality staff.
• Communicate with senior leadership about key deliverables and timelines.

Skills

Quality Improvement

Data Acquisition

Compliance

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 in quality improvement (primarily Medicaid), data capture/supplemental data submission, and 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 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 understanding and compliance.
• Consult with MHI QS leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements.
• Support development of a strategic roadmap and related tools with the assigned plans and MHI QS to 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, ensuring organizational alignment within Molina.
• Bridge high-level performance measures with operational initiatives; monitor intervention effectiveness and identify data gaps; propose interventions to close performance gaps.
• Ensure interventions align with overarching strategy and execution plans.
• Monitor external Correction Action Plans and support departmental activities within standard 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, preparing thoroughly and documenting follow-up actions.
• Coordinate reporting and packaging for leadership meetings.
• Manage materials and analysis supporting communication with the health plan, and initiate team meetings for collaboration.
• Communicate with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Present summaries, key takeaways, and action steps about functional areas in meetings.
• Lead or influence cross-functional teams 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 for accreditation, compliance, HEDIS interventions, potential quality of care issues, and medical record abstraction. Technical and strategy 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.

Interested Molina employees should apply through the intranet job listing. Molina offers a competitive benefits and compensation package. Molina is 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.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting