Job Details

Sentara Health seeks a Remote Quality Improvement Specialist to conduct clinical and documentation reviews of behavioral health claims to ensure medical necessity and regulatory compliance. This role collaborates with providers and compliance teams to ensure accurate reimbursement and adherence to Medicaid and NCQA standards.

The position requires a bachelor's in health administration or related field, with 2+ years in Medicaid/Managed Care and 2+ years in Quality Improvement.