Remote Behavioral Health Quality Improvement Auditor

Sentara Health; Virginia; Hybrid; USD 74.000 - 123.000; Vollzeit

Benefits dieser Stelle

Medical, Dental, Vision plans

401k/403B with employer match

Paid time off and holidays

Tuition assistance and student debtPay

Disability plans and life insurance

Zusammenfassung

Sentara Health seeks a Remote Quality Improvement Specialist to review behavioral health claims for medical necessity and regulatory compliance. This remote role supports multiple states and requires a health administration degree with 2+ years in Medicaid/Managed Care and quality improvement.

The ideal candidate will have strong analytical, communication, and auditing skills, and may hold RN or licensed mental health credentials. Sentara offers extensive benefits and remote work flexibility.

Qualifikationen

• Bachelor's degree in health administration or health-related field.
• RN preferred; LMHP or equivalent preferred.
• 2 years experience with Medicaid/Managed Care and CMS.
• 2 years Quality Improvement experience.

Aufgaben

• Conduct comprehensive clinical and documentation reviews of behavioral health claims prior to payment.
• Evaluate clinical records and validate service delivery.
• Identify documentation deficiencies and recommend payment, denial, or further review.
• Collaborate with providers, clinical teams, compliance, and claims operations.
• Ensure compliance with Medicaid regulations and organizational policies.

Kenntnisse

Medicaid knowledge

Regulatory interpretation

Auditing & documentation

Written & verbal communication

Microsoft Office proficiency

Ausbildung

Bachelor's degree in health administration or health-related field

Registered Nurse (RN) preferred

Licensed Mental Health Professional (preferred)

LCSW/LPC/LMFT/BCBA/LMHP or equivalent

Tools

Audit tracking systems

Claims processing systems

Jobbeschreibung

Sentara Health seeks a Remote Quality Improvement Specialist to review behavioral health claims for medical necessity and regulatory compliance. This remote role supports multiple states and requires a health administration degree with 2+ years in Medicaid/Managed Care and quality improvement.

The ideal candidate will have strong analytical, communication, and auditing skills, and may hold RN or licensed mental health credentials. Sentara offers extensive benefits and remote work flexibility.