Regional Director, Quality Solutions (Remote Eastern Time Zone)

Lensa; West Valley City (UT); 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 initiatives. This role involves liaising between national and local operations, ensuring compliance with quality standards, and managing a team. Ideal candidates will have extensive experience in managed care and quality improvement, with a strong focus on data acquisition and compliance.

Qualifications

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

Responsibilities

• Oversee performance and execution for assigned regional states.
• Act as liaison between national QS organization and health plan leadership.
• Manage QS HPP program manager and coordinate with health plan quality staff.

Skills

Quality Improvement

Data Acquisition

Compliance

Leadership

Education

Bachelor’s Degree in Healthcare Administration

Master’s Degree in a related field

Job description

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

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 related to quality improvement (primarily Medicaid) and data capture/supplemental data submission, as well as 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 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

• Serves as the subject matter expert for all Medicaid / Medicare / Marketplace quality and data acquisition functions to ensure understanding and compliance.
• Consults with MHI QS leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance standards.
• Supports development of a strategic roadmap and related tools with the assigned plans and MHI QS, enabling staff and communicating the strategy to health plan leadership.
• Acts 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.
• Manages the QS HPP program manager and coordinates with health plan quality staff, ensuring organizational alignment with other enterprise teams within Molina.
• Bridges high-level performance measures with operational initiatives; monitors intervention effectiveness and identifies data gaps; proposes interventions and next steps to close performance gaps.
• Ensures interventions align with overarching strategies and execution plans.
• Monitors external Correction Action Plans and supports activities within standard department scope.
• Possesses strong knowledge in data acquisition processes, HEDIS, and quality performance management across all lines of business, with some understanding of accreditation and compliance.
• Participates in Molina national and health plan meetings, preparing thoroughly and documenting follow-up actions.
• Coordinates reporting and materials for leadership meetings.
• Develops and manages communication materials, analysis, and promotes close collaboration to meet KPIs and timelines.
• Communicates with senior leadership about key deliverables, timelines, barriers, and escalation needs.
• Conveys clear strategies and updates on key performance indicators.
• Presents summaries, key takeaways, and action steps effectively in meetings.
• Demonstrates ability to lead or influence cross-functional teams, remotely or in-office.

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 needed for accreditation, compliance, HEDIS interventions, and medical record abstraction. Strategy and technical 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: Please 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.

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