JOB DESCRIPTION

Job Summary

We offer a flexible remote work option, particularly suitable for candidates located in the Eastern Time Zone.

As the Regional Director of Quality Solutions (QS), you will play a pivotal role in shaping the strategic direction for performance improvement and will manage the execution of initiatives across designated regional states within the Health Plan Performance (HPP) team. You will act as the go-to expert in all facets of quality improvement—primarily focusing on Medicaid—and oversee data capture and supplemental data submissions while coordinating both national and local operations. This position involves being the primary liaison between the national QS organization (MHI) and health plan executives, ensuring alignment with established key performance indicators and timelines. Additionally, you will serve as the main point of contact for cross-functional teams and senior leadership at Molina, addressing pressing issues as they arise.

KNOWLEDGE/SKILLS/ABILITIES

• Act as a subject matter expert on quality-related initiatives for Medicaid, Medicare, and Marketplace, guiding participants in understanding and fulfilling compliance obligations.

• Collaborate with MHI QS leaders, national executives, and health plan management to clarify requirements and facilitate training that ensures adherence to compliance standards.

• Assist in crafting a strategic roadmap and relevant tools that communicate the ongoing strategy and objectives to health plan leadership.

• Serve as the intermediary between MHI QS leaders, Centers of Excellence, and health plan executives, providing updates on performance status, risks, needs, and recommendations for adjustments to meet performance targets.

• Directly manage the QS HPP program manager and coordinate efforts with health plan quality teams, ensuring effective organization with other enterprise teams at Molina.

• Link high-level performance measures with operational initiatives, monitor the effectiveness of ongoing interventions, identify data gaps, and propose actionable steps to address performance shortfalls.

• Ensure all interventions align with the broader strategic vision and execution plans.

• Oversee external Corrective Action Plans while supporting departmental activities in accordance with established standards.

• Possess deep knowledge of data acquisition processes, HEDIS, and quality performance management across all lines of business, with a foundational understanding of accreditation and compliance.

• Engage in Molina’s national and health plan meetings, preparing thoroughly in advance and documenting follow-up actions effectively.

• Coordinate the reporting and presentation needs for critical leadership sessions.

• Manage the creation of materials and analyses that underpin effective communication with the health plan, fostering collaboration through team meetings to meet key performance indicators and deadlines.

• Interact with national and health plan senior leadership regarding key deliverables, timelines, barriers, and urgent escalations that require attention.

• Clearly articulate strategies, key performance indicators, and updates in assigned areas.

• Deliver clear and concise presentations that summarize key insights and action steps to national and health plan meetings.

• Exhibit strong leadership capabilities by influencing cross-functional teams, whether they are working remotely or in-office across the country.

JOB QUALIFICATIONS

Required Education

Bachelor’s Degree in a relevant field such as Healthcare Administration or Public Health, or equivalent professional experience.

Required Experience

A minimum of 7 to 10 years of experience in Managed Care and/or health plan quality, with clinical expertise for roles focused on Accreditation, Compliance, HEDIS Interventions, potential quality of care issues, and medical record abstraction. Strategic and technical experience is essential for positions centered on interventions.

Preferred Education

Master’s Degree in a relevant field is highly desirable.

Preferred License, Certification, Association

An RN with a quality background is preferred.

For current Molina employees: If you are interested in pursuing this opportunity, please apply via the intranet job listing.

Molina Healthcare provides a competitive benefits package and salary. We are proud to be an Equal Opportunity Employer (EOE) M/F/D/V.

Salary Range: $97,299 – $189,732 / ANNUAL

Actual compensation may vary based on geographic location, experience, education, and skill level.