Quality Improvement Coordinator/Registered Nurse; RN Health Plan - Remote in Virginia
Job Description & How to Apply Below
City/State
Norfolk, VA
Work Shift
Multiple shifts available
Overview:
Sentara Health Plansis hiring a Quality Improvement Coordinator /Registered Nurse (RN) for the Health Plan - Remote in Virginia!
Status:
Full-time,permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Location:
This position is remote and applicants must be located in Virginia.
There are a total of 3 open positions under the Quality Improvement Coordinator role for the Health Plan (2 for Critical Incident Investigations and 1 for Special Projects).
Overview for Quality Improvement Coordinator for Special Projects
- The Quality Improvement (QI) Coordinator is responsible for leading and coordinating multi-year Quality Improvement initiatives and strategic projects that support population health, regulatory compliance, and performance improvement in alignment with Virginia Medicaid (DMAS), CMS regulations, and Sentara Health Plans (SHP) Quality Program goals.
This role oversees the planning, execution, monitoring, and evaluation of Special Projects, 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 oversight from the Director, to ensure successful project outcomes and sustained quality improvement.
Quality Improvement Project Leadership
- Leads and manages assigned Special Projects, including multi-year (1-3 year) Quality Improvement initiatives designed to improve population health outcomes and meet regulatory and organizational priorities.
- Develops project plans, timelines, milestones, and deliverables, ensuring alignment with SHP strategic goals.
- Monitors project progress, identifies risks, and implements mitigation strategies to ensure successful completion.
- Collaborates with cross-functional teams to advance project objectives and achieve measurable outcomes.
- Prepares and delivers project updates, summaries, and recommendations to leadership, committees, and work groups.
- 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 quality of care indicators.
- Communicates review findings, trends, and opportunities for improvement to providers and internal stakeholders.
- Supports provider education and corrective action follow-up to improve documentation compliance and quality outcomes.
- Coordinates and executes Quality Improvement Team projects focused on performance improvement, regulatory initiatives, and population health priorities.
- Applies quality improvement methodologies to identify performance gaps, root causes, and opportunities for intervention.
- Supports implementation and evaluation of targeted interventions to drive sustained improvement.
- Performs data analysis and trending to identify opportunities for improvement across quality initiatives.
- Develops and maintains reports, dashboards, and visualizations to monitor project progress and performance.
- Tracks and monitors key performance indicators (KPIs) tied to Special Projects and regulatory requirements.
- Translates data into actionable insights and recommendations to support decision-making and continuous improvement.
- Ensures compliance with DMAS contract requirements, CMS regulations (including 42 CFR
• 438), and SHP Quality Program standards. - Maintains accurate documentation and tracking of project activities, outcomes, and regulatory requirements.
- Prepares reports, data, and supporting documentation for audits, regulatory reviews, and oversight activities.
- Supports continuous quality improvement efforts through data-driven analysis, performance monitoring, and intervention design.
- Assists with development and monitoring of corrective action plans (CAPs) to ensure sustained improvement.
- Promotes a culture of quality, accountability, and regulatory readiness across initiatives.
- Develops and maintains Quality Improvement tracking tools, including Excel-based trackers and project management resources.
- Utilizes reporting platforms and data systems to track, analyze, and report on quality initiatives.
- Ensures accuracy and integrity of data used for reporting and performance monitoring.
- 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 quality initiatives.
- Provides education and guidance related to quality improvement, documentation…
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