Quality Improvement Coordinator​/Registered Nurse; RN - Remote

City/State:
Norfolk, VA

Work Shift:

Multiple shifts available

Status:
Full-time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, Monday through Friday

Location:

Remote; candidates must be located in Virginia

Sentara Health Plans is hiring a Quality Improvement Coordinator / Registered Nurse (RN) for remote positions in Virginia. Three identical roles are available: two focused on Critical Incident Investigations and one on Special Projects.

• Lead and manage multi-year Quality Improvement initiatives to improve population health outcomes and meet regulatory priorities.
• Develop project plans, timelines, milestones, and deliverables in alignment with Sentara Health Plans strategic goals.
• Monitor project progress, identify risks, and implement mitigation strategies.
• Collaborate with cross‑functional teams to advance project objectives and achieve measurable outcomes.
• Prepare and deliver project updates, summaries, and recommendations to leadership, committees, and work groups.
• Conduct monthly EPSDT Provider Documentation Medical Record Reviews in accordance with DMAS requirements.
• Evaluate medical records for compliance with documentation standards, completeness, and quality of care indicators.
• Communicate review findings, trends, and improvement opportunities to providers and stakeholders.
• Support provider education and corrective action follow‑up to improve documentation compliance and quality outcomes.
• Coordinate and execute Quality Improvement Team projects focused on performance improvement, regulatory initiatives, and population health priorities.
• Apply quality improvement methodologies to identify performance gaps, root causes, and opportunities for intervention.
• Support implementation and evaluation of targeted interventions to drive sustained improvement.
• Perform data analysis and trending to identify opportunities for improvement across quality initiatives.
• Develop and maintain reports, dashboards, and visualizations to monitor project progress and performance.
• Track and monitor key performance indicators tied to Special Projects and regulatory requirements.
• Translate data into actionable insights and recommendations to support decision‑making and continuous improvement.
• Ensure compliance with DMAS contract requirements, CMS regulations, and Sentara Health Plans Quality Program standards.
• Maintain accurate documentation and tracking of project activities, outcomes, and regulatory requirements.
• Prepare reports, data, and supporting documentation for audits, regulatory reviews, and oversight activities.
• Support continuous quality improvement efforts through data‑driven analysis, performance monitoring, and intervention design.
• Assist with development and monitoring of corrective action plans (CAPs) to ensure sustained improvement.
• Promote a culture of quality, accountability, and regulatory readiness across initiatives.
• Develop and maintain Quality Improvement tracking tools, including Excel‑based trackers and project management resources.
• Utilize reporting platforms and data systems to track, analyze, and report on quality initiatives.
• Guarantee accuracy and integrity of data used for reporting and performance monitoring.
• Collaborate with internal departments such as Care Management, Care Coordination, Value‑Based Care, Network Management, Compliance, and other stakeholders.
• Engage with providers and external partners to support EPSDT reviews and quality initiatives.
• Provide education and guidance related to quality improvement, documentation requirements, and regulatory expectations.

• Receive, review, and coordinate Critical Incident reports, including abuse, neglect, exploitation, sentinel events, mortality reviews, and serious quality concerns, per DMAS and CMS requirements.
• Ensure timely reporting, investigation, follow‑up, and closure of Critical Incidents within required regulatory time frames.
• Conduct comprehensive reviews of medical records, incident reports, and supporting documentation to assess care appropriateness and member…