Job Description

Job Description

City/State

Doral, FL

Overview

Work Shift

First (Days) (United States of America)

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Remote Quality Improvement Specialist .

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming

In collaboration with clinical leadership, this position plays a vital role in managing quality improvement and quality assurance activities for the designated program(s).Primary responsibilities include developing, implementing and coordinating activities to ensure compliance with NCQA accreditation requirements, and state and federal quality measures, initiatives and guidelines. Responsibilities also entail collaborating with assigned areas to develop, implement and measure quality improvement initiatives designed to improve patient care, patient safety and reduce costs. Quality improvement and assurance activities include but are not limited to collecting and analyzing data; implementing, tracking and reporting on quality activities and interventions; developing and maintaining policies & procedure to ensure compliance to quality activities and standards; auditing and committee participation. Requirements:

• Bachelor's degree in health administration or health-related field required.
• 2 years working with (cumulatively) Managed Care, CMS, NCQA Health Plan Standard and Quality Improvement.
• HEDIS experience.
• Strong Analytical Skills.
• High level in Excel
• All licenses must be maintained in area of specialty. May require local travel.

Our Benefits:

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others
• Work Perks program including discounted movie and theme park tickets among other great deals
• Opportunities for further advancement within our organization
  Sentara employees strive to make our communities healthier places to live. We are setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
  Join our team! We are committed to quality healthcare, improving health every day, and providing the opportunity for training, development, and growth!

  Sentara Health offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Keywords: Talroo-health Plan, #Indeed, Managed Care, CMS, NCQA, Quality Improvement

Job Summary

In collaboration with clinical leadership, this position plays a vital role in managing quality improvement and quality assurance activities for the designated program(s). Primary responsibilities include developing, implementing and coordinating activities to ensure compliance with NCQA accreditation requirements, and state and federal quality measures, initiatives and guidelines. Responsibilities also entail collaborating with assigned areas to develop, implement and measure quality improvement initiatives designed to improve patient care, patient safety and reduce costs. Quality improvement and assurance activities include but are not limited to: collecting and analyzing data; implementing, tracking and reporting on quality activities and interventions; developing and maintaining policies & procedure to ensure compliance to quality activities and standards; auditing and committee participation.

Bachelor's degree in Health Administration or health-related field required. 2 years working with (cumulatively) Medicaid Managed Care , CMS, NCQA Health Plan Standard and 2 years Quality Improvement required.

All licenses must be maintained in area of specialty. May require local travel.

Qualifications:

BLD - Bachelor's Level Degree (Required)

Managed Care, Medicaid, Quality Improvement

Skills

Communication, Complex Problem Solving, Coordination, Critical Thinking, Instructing

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.

Job Tags

Remote job, Local area, Flexible hours, Shift work,

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