Full time
Posted Today
JR-37721

City/State

Norfolk, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Health Plans is currently hiring a Quality Improvement Accreditation Coordinator!

This is a Full Time position with day shift hours and great benefits!

Remote opportunities available in Virginia and North Carolina

Job Requirements:

• Associates or Bachelors level Degree in Nursing
• Registered Nurse License
• In lieu of RN, Masters of Health Services Administration, MSW, MBA or Masters of Health Administration.
• 3 years experience working in Quality Improvement
• 3 years experience working in Clinical Setting
• NCQA Accreditation, DNV Accreditation or joint Commission Accreditation experience preferred
• Behavorial health experience preferred

Primary responsibilities include:

• Coordinates the design, development, implementation, and evaluation of the heath plan’s clinical quality functions
• Assists in developing focused and/or specialized studies based on high volume, high risk, high cost, and/or problem prone areas, and periodically monitors and evaluates related performance goals
• Collaborates with Clinical Care Services to improve health status for chronic diseases based on demographic and epidemiological characteristics of the membership
• Assists in maintaining accreditation and certifications for NCQA and MCHIPS, as well as assisting to meet the requirements for state and federal (DMAS and CMS) regulations and requirement

Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Keywords: Health Plan, Virginia Premier, Optima, Quality Improvement, Quality Assurance, MCO, Medical Care Management, RN, Registered Nurse

Job Summary

The Quality Improvement Coordinator is responsible for coordinating the design, development, implementation, and evaluation of the heath plan’s clinical quality functions. Assists in developing focused and/or specialized studies based on high volume, high risk, high cost, and/or problem prone areas, and periodically monitors and evaluates related performance goals. Collaborates with Clinical Care Services to improve health status for chronic diseases based on demographic and epidemiological characteristics of the membership. Assists in maintaining accreditation and certifications for NCQA and MCHIPS, as well as assisting to meet the requirements for state and federal (DMAS and CMS) regulations and requirement.

Bachelor’s Degree preferred; minimum of an Associate’s or Trade School Degree required

Knowledge and understanding of regulatory and accreditation processes required

For Sentara Health Plans – In lieu of RN, Masters of Health Services Administration, MSW, MBA or Masters of Health Administration.

Qualifications:

ALD – Associate’s Level Degree (Required), BLD – Bachelor’s Level Degree

Registered Nurse License (RN) – Compact/Multi-State License, Registered Nurse License (RN) – North Carolina, Registered Nurse License (RN) – Virginia

Clinical, Quality Improvement

Skills

Microsoft Office

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.