Sentara Health Plans is hiring a Quality Improvement Coordinator /Registered Nurse (RN) - Remote in Virginia! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: This position is remote and applicants must be located in Virginia. There are 2 open positions responsible for handling critical incident investigations and 1 open position dedicated to managing special projects as directed by DMAS and CMS.

Overview

• 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.

Education

• Associate’s Degree REQUIRED or
• LPN Diploma may be accepted in lieu of associate’s degree

Experience

• 3 years of quality improvement experience REQUIRED
• 3 years of regulatory and accreditation REQUIRED
• Nursing background in different settings (acute, ambulatory, home health, hospice, behavioral health) preferred
• Health Plan experience preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. 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. 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! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-100510 Talroo-Health Plan Quality Improvement Coordinator, Registered Nurse, RN, Nursing, Remote, Health Plan, Healthcare, MCO, Managed Care, Health Insurance, Quality Improvement, Regulation, Accreditation, DMAS, CMS