Job Description
Sentara Health Plans is hiring an Quality Improvement Coordinator/RN- Remote! Status: Full-time, permanent position (40 hours) Standard working hours: Weekend Days, Friday to Monday. With Flexible start time between 6am to 9am (4x10 shift). Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming.
Primary responsibilities include: • The Consultant is responsible for ensuring denial letters, along with other regulatory and accreditation work, are completed and meeting requirements as dictated by the governance and accreditation standards. Key responsibilities include completion of denial letters following accreditation, federal and state requirements, along with assisting with additional work to support BH UM's adherence to compliance and regulatory requirements. Education: • Minimum of an Associate's or Trade School Degree REQUIRED • Bachelors Degree in Nursing preferred Certification/Licensure • Registered Nurse (RN) License (Compact/Multistate or Virginia) REQUIRED • For Sentara Health Plans - In lieu of RN, Masters of Health Services Administration, Masters in Social Work (MSW), Masters in Business Administration (MBA) or Masters of Health Administration.
Experience: • 3 years of Quality Improvement experience REQUIRED • 3 years of Clinical experience REQUIRED • Knowledge and understanding of regulatory and accreditation processes REQUIRED 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-90216 Talroo - Nursing Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, Virginia, RN, VA, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Quality improvement, utilization management, Denial, behavioral health, BH, weekend days Apply tot his job