Sentara Healthcare

  • Virginia Beach, VA, USA
Sentara Healthcare Remote * (Richmond, VA, USA)
Sep 18, 2021
Sentara Health Plan is currently hiring anQuality Improvement CoordinatorFor Virginia Premier!This is a Full Time position with day shift hours and great benefits! Candidates may work remotely in VA, NC, WA, NV, FL, IN, SD, GA, SC, TN, TX, WV and WI!Job Requirements:RN-Bachelor's Level DegreeRequired: Clinical - 3 years, Quality Improvement - 3 yearsRequired: Registered NurseKnowledge and understanding of regulatory and accreditation processes requiredPreferred: Managed Care or Health Plan experienceRequires travel for quarterly audits.Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in...
Sentara Healthcare Remote * (Norfolk, VA, USA)
Sep 18, 2021
Sentara Health Plan is currently hiring anPopulation Health Performance Improvement Coordinator-NorfolkFor Optima Health!This is a Full Time position with day shift hours and great benefits!Position can work remotely in VA. Job Requirements:RN-Bachelor's Level Degree - NURSINGRequired: Health Insurance Industry - 5 years, Healthcare - 5 yearsRequired: Registered NurseExperience with HEDIS (Healthcare Effectiveness Data and Information Sets), CAHPS (Consumer Assessment of Healthcare Providers and Systems), DMAS (Department of Medical Assistance Services)-Medicaid Performance Withhold Programs. Preferred: Excellent communication and presentation skillsSentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans,...
Sentara Healthcare Remote * (Afton, WY 83110, USA)
Sep 18, 2021
Sentara Health Plan is currently hiring anTeam Coordinator, Integrated Care Manager-Chesapeakefor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position can work remotely in Virginia. Job Requirements:RN-Bachelor's Level DegreeRequired: Case Management - 3 yearsPreferred: Supervisory - Previous experienceRequired: Registered NurseFor Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM or RN-BC)Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in the insurance business and 20 years'...
Sentara Healthcare Remote * (Virginia Beach, VA, USA)
Sep 18, 2021
Sentara Health Plans is currently hiring an Sr Healthcare Data Analyst for Optima Health! This is a Full Time position with day shift hours and great benefits! Candidates may work remotely in VA, NC, WA, NV, FL, IN, SD, GA, SC, TN, TX, WV and WI! Job Requirements: Bachelor's Level Degree Data Analysis - 3 years, Preferred: Financial Analysis - 1 year, Population Management - 1 year, Statistics - 1 year Required: SQL and Tableau experience Required: Medicare STARS OR extensive HEDIS experience Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years' experience in the insurance business...
Sentara Healthcare Remote * (Elizabeth City, NC 27909, USA)
Sep 16, 2021
Sentara Healthcare is currently recruiting for aDIR, Network Management (VA West Region)to work with our Optima Health Plan.Responsible for developing and maintaining statewide provider networks to include provider contracting and negotiation, education, program implementation and ongoing issue resolution. Responsibilities also include the development of goals, objectives, and policies that support the strategic objectives of the division. Responsible for day-to-day leadership and development of assigned members of the team.Travel required throughout VA to meet with Providers. Ideal candidate will live in VA or NC. Will consider a telecommute opportunity, if not near an office and you live in one of the following states:Virginia, North Carolina, Florida, Nevada, Wyoming, South Dakota, Washington State, Indiana, Georgia, South Carolina, Tennessee, Texas, West Virginia and Wisconsin. Will be responsible for the following Network Management responsibilities:Manage a team contract...
Sentara Healthcare Remote * (Richmond, VA, USA)
Sep 15, 2021
Sentara Health Plans is currently hiring aSr Business Analystfor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position is located in Glen Allen, VA.Job Requirements:Education: Bachelor's Level Degree; Master's degree preferredRequired: Analytics - 3 years, Healthcare - 3 years, Strong SQL and EXCEL experience, Project Management - 3 yearsPreferred skills: Tableau, problem solving, MS Office Suite (Strong in excel)Preferred: Prior experience with encounter data submissionPreferred: Prior experience with CMS-HCC modelsPreferred: Six Sigma Green BeltJob Responsibilities:Responsible for developing and extensive expertise in the data and systems leveraged by the Revenue Management teamDevelop expertise in CMS Medicare, HHS Exchange, and Medicaid data and risk adjustment including: risk score calculation and financial risk receivable calculationsDevelop expertise in, Risk Adjustment Processing System (RAPS), Encounter Data Processing System (EDPS),...
Sentara Healthcare Remote * (Glen Allen, VA, USA)
Sep 14, 2021
Sentara Health Plans is currently hiring anBusiness Analyst-Operations- Glen Allenfor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position can work remotely in VA, NC, WA, NV , FL, IN, SD, WY! Job responsibilities:The Business Analyst position is responsible for the Quality Assurance (QA) review of system configuration changes made to VPHP's claims processing, editing and pricing systems. The Business Analyst plays a key role in identifying, reviewing, and documenting all results related to the QA review of these system changes. In addition, the analyst will perform pre /post payment random and focus audits. The analyst will develop a working knowledge of the system configuration of business rules that support coverage of services, as well as the system configuration of contracts and fee schedules that support reimbursement.Job Requirements: Experience in lieu of education: YesRequired: Information Technology - 1 yearStrongly preferred:...
Sentara Healthcare Remote * (Richmond, VA, USA)
Sep 12, 2021
Sentara is currently hiring anClaims SpecialistFor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position can work remotely in VA. Job Requirements:Bachelor's Level Degree - Experience in lieu of education: YesRequired: Related - 3 years4 years related experience in lieu of Bachelor's degree required. Preferred: Experience in Claims adjudication systemPreferred: Proficient with Microsoft Office Applications; Skills: Active Learning, Active Listening, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Negotiation, Reading Comprehension, Social Perceptiveness, Speaking, WritingSentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee...
Sentara Healthcare Remote * (Norfolk, VA, USA)
Sep 12, 2021
Sentara Health Plans is currently hiring anClaims ProcessorFor Optima Health!This is a Full Time position with day shift hours and great benefits!Position can work remotely in VA. Job Requirements:Education: High School Grad or EquivalentRequired: Administrative - 1 year, Customer Service - 1 yearPreferred: Claims or Insurance experience; Healthcare experience (Hospital, Managed Care)Skills: Problem solving skills, Analytical Skills, Critical thinking, Proficient in MS Office and Computer SkillsSentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in the insurance business and 20 years'...
Sentara Healthcare Remote * (Afton, VA 22920, USA)
Sep 12, 2021
Sentara Health Plans is currently hiring anClaims Processor IIfor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position can work remotely in Virginia! Job Requirements:Required: High School Grad or EquivalentRequired: Administrative - 1 year, Customer Service - 1 year, Health Plan Claims Disbursmnts - 1 yearPreferred: Claims processing or Insurance experience; Healthcare experience (Hospital, Managed Care)Preferred QNXT and Macess experienceMust meet or exceed current claims processing standards to include: financial, check and processing accuracies.Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and...
Sentara Healthcare Remote * (Richmond, VA, USA)
Sep 07, 2021
Sentara Healthcare is seeking a Sr Business Analyst to join their team!This position is responsible for the implementation and support of quality initiatives within assigned areas.Provides subject matter expertise related to quality initiative implementation, reporting and analysis.Is a liaison between internal/external customers and Information Technology for business definition, scope, testing and implementation to ensure quality, efficiency, effectiveness, and customer knowledge to improve business practices.Possesses a high degree of operational knowledge as it relates to customer operations in claims, system administration, expansion business, and member enrollment.Must have strong SQL skills and excellent understanding of MS ExcelSentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including...
Sentara Healthcare Remote * (Elizabeth City, NC 27909, USA)
Aug 26, 2021
Sentara Health Plans is currently hiring anSr Business System Analyst- QNXTfor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Position can work remotely in VA, NC, WA, NV , FL, IN, SD, WY!Job responsibilities:The Sr. Business Systems Analyst perform activities that provide business solutions to complex organizational initiatives and should demonstrate an extensive expertise in the claim's platform and all interfacing applications, both customized and packaged. This individual should possess a high degree of expertise in the business requirements that support reimbursement policies and methodologies of the organization, as well as perform complex data analysis and draw business conclusions for decision making. The analyst will coordinate the maintenance of assigned Claims Department systems for the program and play a key role in the configuration and implementation of new markets and products. The analyst should consider interdepartmental impact...