Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; Tucson (AZ); 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 within healthcare plans. This remote role requires expertise in Medicaid and quality management, along with strong leadership skills. The ideal candidate will manage a team, ensure compliance, and facilitate communication between various stakeholders to meet key performance indicators. Join a dynamic team dedicated to enhancing healthcare quality and outcomes.

Qualifications

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

Responsibilities

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

Skills

Data Acquisition

Quality Improvement

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 the strategic performance improvement and overseeing performance and execution within assigned regional states for the Health Plan Performance (HPP) team. Key activities include serving as a subject matter expert in quality improvement (primarily Medicaid), data capture, and supplemental data submission, as well as coordinating national and local operations. This person will act as a liaison between the national QS organization (MHI) and health plan leadership to ensure KPIs and timelines are met, and serve as the primary contact for cross-functional teams and senior leadership 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 for ongoing compliance.
• Support the development of a strategic roadmap and tools with assigned plans and MHI QS, enabling staff and communicating strategies to health plan leadership.
• Act as a liaison between MHI QS, Centers of Excellence, and health plan leadership, sharing performance status, risks, needs, and suggested modifications.
• 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 gaps.
• Ensure interventions align with overarching strategies and execution plans.
• Monitor external Correction Action Plans and support related activities within the department's scope.
• Possess strong knowledge of data acquisition, HEDIS, and quality performance management across 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 presentation materials for leadership meetings.
• Develop and manage materials and analyses supporting communication 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 escalations.
• Present summaries, key takeaways, and action steps clearly to leadership teams.
• 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 related field.

Required Experience

7-10 years in Managed Care and/or health plan quality. Clinical experience for accreditation, compliance, HEDIS interventions, or 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 current Molina employees: Apply through the intranet job listing.

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.

Seniority level

• Director

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• IT Services and IT Consulting