Molina Healthcare · 1 month ago
Regional Director, Risk & Quality Solutions
United States
Full-time
Remote
Director/Executive
$107K/yr - $228K/yr
7+ years expMolina Healthcare is a leading organization in healthcare services, and they are seeking a Regional Director for Risk & Quality Solutions. This role is responsible for overseeing performance improvement initiatives and serving as the liaison between the national organization and health plan leadership to ensure compliance and performance goals are met.
Health CareHospitalMedical
Responsibilities
Serves as the subject matter expert for all risk, quality, and data acquisition functions to ensure participants understands and meets compliance requirements
Consults with MHI RQES leaders, national and health plan leadership to facilitate understanding of requirements and staff training to ensure ongoing activities meet compliance requirements
Supports development of a strategic roadmap and related tools with the assigned plans and MHI RQES that enables staff and communicates the strategy and roadmap ongoing to health plan leadership
Liaison between MHI RQES leaders, Centers of Excellence and Health Plan leadership including sharing of performance status, risks, needs and suggested modifications to current plan to achieve performance goals
Direct management of RQES provider engagement staff with coordination of health plan provider engagement staff. Ensure organization with other provider engagement teams within Molina
Possesses a strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some understanding of accreditation and compliance
Participate in Molina national and health plan meetings, including comprehensive preparation beforehand (e.g., communication and briefing with national and regional senior leadership teams) and documentation of assigned follow-up actions
Coordinate reporting and packaging needs for critical leadership meetings
Responsible for management and development of materials, analysis supporting ongoing communications with the health plan. Initiates team meetings to promote close collaboration and meet defined key performance indicators and timelines
Communicates with national and health plan Senior Leadership Teams, including national and health plan quality leadership and other team members about key deliverables, timelines, barriers, and escalation that need immediate attention
Communicates a clear strategy with key performance indicators and updates in assigned areas
Presents concise summaries, key takeaways, and action steps about functional area to national and health plan meetings
Demonstrates ability to lead or influence a cross-functional team with staff in remote or in-office locations throughout the country
Qualification
Required
Bachelor's Degree in a related field (Healthcare Administration, Public Health or equivalent experience)
At least 7 - 10 years of experience in Managed Care and/or health plan quality
Clinical experience is needed for positions that are focused on Accreditation, Compliance, HEDIS Interventions, Potential Quality of Care issues, and medical record abstraction
Technical and strategy experience is needed for positions focused on interventions
Preferred
Master's Degree in a related field
RN with Quality Background is preferred
Benefits
Competitive benefits and compensation package
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (56)
2024 (45)
2023 (43)
2022 (31)
2021 (35)
2020 (55)
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
2026-01-17
Company data provided by crunchbase