Remote Quality Improvement Coordinator RN, VA

Sentara

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Full time
Posted Today
JR-37274

City/State

Virginia Beach, VA

 

 

Overview

 

Work Shift

First (Days) (United States of America)

 

 

Sentara Health Plans is currently hiring a Medicare Quality Improvement Coordinator in Richmond or Virginia Beach, VA.

 

This remote position requires travel for onsite visits to a provider’s office 1-2x quarterly.

 

Job Requirements:

  • Bachelors level Degree in Nursing
  • Registered Nurse License
  • 3 years experience working in Quality Improvement
  • 3 years experience working in Clinical Setting

 

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

 

 

Qualifications:

 

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

 

 

Registered Nurse License (RN) – Alabama – Alabama, Registered Nurse License (RN) – Alabama – Alabama, Registered Nurse License (RN) – Arizona – Arizona, Registered Nurse License (RN) – Arkansas – Arkansas, Registered Nurse License (RN) – Colorado – Colorado, Registered Nurse License (RN) – Delaware – Delaware, Registered Nurse License (RN) – Florida – Florida, Registered Nurse License (RN) – Georgia – Georgia, Registered Nurse License (RN) – Idaho – Idaho, Registered Nurse License (RN) – Indiana – Indiana, Registered Nurse License (RN) – Iowa – Iowa, Registered Nurse License (RN) – Kansas – Kansas, Registered Nurse License (RN) – Kentucky – Kentucky, Registered Nurse License (RN) – Louisiana – Louisiana, Registered Nurse License (RN) – Maine – Maine, Registered Nurse License (RN) – Maryland – Maryland, Registered Nurse License (RN) – Mississippi – Mississippi, Registered Nurse License (RN) – Missouri – Missouri, Registered Nurse License (RN) – Montana – Montana, Registered Nurse License (RN) – Nebraska – Nebraska, Registered Nurse License (RN) – New Hampshire – New Hampshire, Registered Nurse License (RN) – New Jersey – New Jersey, Registered Nurse License (RN) – New Mexico – New Mexico, Registered Nurse License (RN) – North Carolina, Registered Nurse License (RN) – North Dakota – North Dakota {+ 10 more}

 

 

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.