Regional Director, Risk & Quality Solutions

Molina Healthcare

13d•$107,028 - $208,705

About The Position

Regional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional states. Key activities include serving as the subject matter expert in all functional areas in risk, data capture and quality improvement, coordinating national and local operations and management of RQES provider engagement staff. This person will be the liaison between the national RQES organization (MHI) and health plan leadership to ensure that the team meets defined key performance indicators and timelines and serving as the primary contact and escalation point for cross-functional teams and senior leadership within Molina to address critical issues.

Requirements

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.

Nice To Haves

Master's Degree in a related field
RN with Quality Background is preferred

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.