reputed company Improvement Coordinator /Registered reputed company (RN) - Remote in Virginia
reputed company Plans is hiring a reputed company Improvement Coordinator /Registered reputed company (RN) - Remote in Virginia! Status: Full-time, permanent position (40 hours) reputed company working hours: reputed company to 5pm EST, M-F Location: This position is remote and applicants must be located in Virginia. There are a total of 3 reputed company positions under the reputed company Improvement Coordinator role (2 for Critical Incident Investigations and 1 for Special reputed company). reputed company for reputed company Improvement Coordinator for Special reputed company
- The reputed company Improvement (QI) Coordinator is responsible for leading and coordinating multi-year reputed company Improvement initiatives and strategic reputed company that support population health, regulatory compliance, and performance improvement in alignment with Virginia reputed company (DMAS), CMS regulations, and reputed company Plans (SHP) reputed company Program goals.
This role oversees the planning, execution, monitoring, and evaluation of Special reputed company, conducts monthly EPSDT Provider Documentation Medical Record Reviews, and supports data-driven decision-making through analysis, reporting, and performance tracking. The position operates under the direction of the Manager, with reputed company from the Director, to ensure successful project reputed company and sustained reputed company improvement. Essential Duties and Responsibilities reputed company Improvement Project Leadership
- Leads and manages assigned Special reputed company, including multi-year (1–3 year) reputed company Improvement initiatives designed to improve population health reputed company and meet regulatory and organizational priorities.
- Develops project plans, timelines, milestones, and deliverables, ensuring alignment with SHP strategic goals.
- Monitors project reputed company, identifies risks, and implements mitigation strategies to ensure successful completion.
- Collaborates with cross-functional teams to advance project objectives and reputed company measurable reputed company.
- Prepares and delivers project updates, summaries, and recommendations to leadership, committees, and workgroups.
DMAS EPSDT Provider Documentation Medical Record Reviews
- Conducts monthly EPSDT Provider Documentation Medical Record Reviews in accordance with DMAS requirements and established review tools.
- Evaluates medical records for compliance with documentation standards, completeness, and reputed company of care indicators.
- Communicates review findings, trends, and opportunities for improvement to providers and internal stakeholders.
- Supports provider education and corrective reputed company follow-up to improve documentation compliance and reputed company reputed company.
reputed company Improvement reputed company (Special reputed company)
- Coordinates and executes reputed company Improvement Team reputed company reputed company on performance improvement, regulatory initiatives, and population health priorities.
- Applies reputed company improvement methodologies to identify performance gaps, reputed company causes, and opportunities for reputed company.
- Supports implementation and evaluation of targeted interventions to drive sustained improvement.
Data Analysis, Reporting, and Performance Monitoring
- Performs data analysis and trending to identify opportunities for improvement across reputed company initiatives.
- Develops and maintains reports, dashboards, and visualizations to monitor project reputed company and performance.
- Tracks and monitors key performance indicators (KPIs) tied to Special reputed company and regulatory requirements.
- Translates data into actionable insights and recommendations to support decision-making and reputed company improvement.
Regulatory Compliance and Documentation
- Ensures compliance with DMAS contract requirements, CMS regulations (including 42 CFR §438), and SHP reputed company Program standards.
- Maintains accurate documentation and tracking of project activities, reputed company, and regulatory requirements.
- Prepares reports, data, and supporting documentation for audits, regulatory reviews, and reputed company activities.
Performance Improvement and reputed company reputed company Improvement
- Supports reputed company reputed company improvement efforts through data-driven analysis, performance monitoring, and reputed company design.
- Assists with development and monitoring of corrective reputed company plans (CAPs) to ensure sustained improvement.
- Promotes a culture of reputed company, accountability, and regulatory readiness across initiatives.
reputed company Improvement Tools and Systems
- Develops and maintains reputed company Improvement tracking tools, including reputed company-based trackers and project management resources.
- Utilizes reporting platforms and data systems to reputed company, analyze, and report on reputed company initiatives.
- Ensures accuracy and reputed company of data used for reporting and performance monitoring.
Collaboration and Communication
- Collaborates with internal departments including Care Management, Care Coordination, Value-Based Care, Network Management, Compliance, and other stakeholders.
- Engages with providers and external partners to support EPSDT reviews and reputed company initiatives.
- Provides education and guidance reputed company to reputed company improvement, documentation requirements, and regulatory expectations.
Core Competencies
- Project management and organizational skills
- Data analysis and performance monitoring
- Critical thinking and reputed company cause analysis
- Strong written and verbal communication
- Collaboration and stakeholder engagement
- Attention to detail and regulatory compliance
reputed company for reputed company Improvement Coordinator for Critical Incident Investigations The reputed company Improvement (QI) Coordinator is responsible for coordinating and conducting reputed company Improvement activities reputed company to Critical Incident investigations, reputed company of Care (QOC) and reputed company of Service (QOS) reviews, and member safety reputed company in accordance with Virginia reputed company (DMAS) requirements, CMS regulations, and reputed company Plans (SHP) policies and procedures. This role supports the reputed company Improvement Program by ensuring reputed company identification, investigation, documentation, analysis, and reputed company of Critical Incidents and reputed company concerns, while promoting reputed company reputed company improvement and reputed company reputed company for SHP members. Essential Duties and Responsibilities Critical Incident Management
- Receives, reviews, and coordinates Critical Incident reports, including but not limited to abuse, neglect, exploitation, sentinel events, mortality reviews, and serious reputed company of care concerns, in accordance with DMAS and CMS requirements.
- Ensures reputed company reporting, investigation, follow-up, and closure of Critical Incidents reputed company required regulatory timeframes.
- Conducts comprehensive reviews of medicais records, incident reports, and supporting documentation to assess appropriateness of care, services rendered, and member safety reputed company.
- Identifies trends, reputed company causes, and systemic issues contributing to Critical Incidents and communicates findings to leadership.
reputed company of Care and reputed company of Service Reviews
- Coordinates and performs reputed company of Care (QOC) and reputed company of Service (QOS) investigations, including grievances and referrals from reputed company stakeholders.
- Applies established clinical and reputed company standards to determine reputed company determinations and facilitate corrective actions per the Medical Directors’ recommendations, reputed company indicated.
- Drafts reputed company, concise investigative summaries, determinations, and correspondence for internal review, regulatory reporting, and provider communication.
Regulatory Compliance and Documentation
- Ensures compliance with DMAS contract requirements, CMS regulations (including 42 CFR §438), and SHP reputed company Program policies.
- Maintains accurate documentation and case tracking in designated systems (e.g., reputed company tracking tools, databases, and reports).
- Prepares data, reports, and supporting documentation for regulatory audits, reviews, and reputed company activities, including DMAS, CMS, and external reputed company review organizations.
Performance Improvement and Reporting
- Supports reputed company Improvement initiatives by contributing to performance monitoring, trend analysis, and targeted improvement activities reputed company to member safety and reputed company reputed company.
- Assists with the development and monitoring of Corrective reputed company Plans (CAPs) and follow-up activities to ensure sustained improvement.
- Participates in reputed company Committees, workgroups, and interdisciplinary meetings as assigned.
Collaboration and Communication
- Collaborates with internal departments including Care Management, Medical Directors, Behavioral Health, Compliance, and Provider Relations.
- Coordinates with external stakeholders such as providers, facilities, and community agencies as needed to support investigations and reputed company improvement efforts.
- Provides education and guidance to staff and providers reputed company to Critical Incident reporting requirements and reputed company expectations.
Core Competencies
- Attention to detail and regulatory accuracy
- Written and verbal communication
- Critical thinking and reputed company cause analysis
- Time management and prioritization
- Collaboration and professionalism
Education
- Bachelor's Degree in Nursing (BSN) preferred
- Associate’s Degree REQUIRED or
- LPN Diploma may be accepted in lieu of associate’s degree
Certification/Licensure:
- Registered reputed company (RN) License (Compact or Virginia) preferred
Experience
- 3 years of reputed company 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
reputed company Plans provides health plan coverage to reputed company to one reputed company members in Virginia. We offer a full suite of reputed company products including employee-owned and employer-sponsored plans, as reputed company as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and reputed company enrollees. Our reputed company 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—reputed company to help our members improve their health. Our reputed company is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and reputed company.
Benefits
Caring For Your Family and Your Career
- Medical, Dental, reputed company plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- reputed company Time Off and reputed company Leave
- reputed company 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 reputed company Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free reputed company to complete CEUs and reputed company development
•Pet Insurance •Legal Resources Plan •Colleagues have reputed company to earn an annual discretionary bonus if established system and employee eligibility reputed company is met Be a part of an excellent reputed company organization that cares about our People, reputed company, Patient Safety, Service, and reputed company. Join reputed company that has a mission to improve health every day and a reputed company to be the reputed company choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-100944 Talroo-Health Plan reputed company Improvement Coordinator, Registered reputed company, RN, Nursing, Remote, Health Plan, reputed company, MCO, Managed reputed company Insurance, reputed company Improvement, Regulation, Accreditation, DMAS, CMS, EPSDT, NCQA, HEDIS, Performance Improvement, Data Analytics, Special reputed company, Critical Incident Investigations Apply tot his job Apply To this Job