Quality Improvement Coordinator /Registered Nurse (RN) - Remote in Virginia
About The Position
Sentara Health Plans is hiring a Quality Improvement Coordinator / Registered Nurse (RN) - Remote in Virginia. This is a full-time, permanent position (40 hours) with standard working hours of 8am to 5pm EST, Monday through Friday. The 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. The Quality Improvement Coordinator is responsible for coordinating the design, development, implementation, and evaluation of the health plan's clinical quality functions. This role 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. The coordinator collaborates with Clinical Care Services to improve health status for chronic diseases based on demographic and epidemiological characteristics of the membership. Additionally, this role 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 requirements.
Requirements
- Associate’s Degree REQUIRED or LPN Diploma may be accepted in lieu of associate’s degree
- 3 years of quality improvement experience REQUIRED
- 3 years of regulatory and accreditation REQUIRED
- Applicants must be located in Virginia.
Nice To Haves
- Nursing background in different settings (acute, ambulatory, home health, hospice, behavioral health) preferred
- Health Plan experience preferred
Responsibilities
- Coordinating the design, development, implementation, and evaluation of the health plan's clinical quality functions.
- Assisting in developing focused and/or specialized studies based on high volume, high risk, high cost, and/or problem prone areas.
- Periodically monitoring and evaluating related performance goals.
- Collaborating with Clinical Care Services to improve health status for chronic diseases based on demographic and epidemiological characteristics of the membership.
- Assisting in maintaining accreditation and certifications for NCQA and MCHIPS.
- Assisting to meet the requirements for state and federal (DMAS and CMS) regulations and requirements.
- Handling critical incident investigations.
- Managing special projects as directed by DMAS and CMS.
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
