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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
Sentara Health Plans is hiring a Qualified Health Plan (QHP) & Business Support Manager- Remote!
Status: Full-time, permanent position (40 hours)
Work hours: 8am to 5pm EST, M-F
Location: Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming!
Job responsibilities:
The Qualified Health Plan (QHP) & Business Support Manager, leads and conducts the completion of templates and binders for Qualified Health Plan (QHP) submission. This role ensures alignment of business processes with state and federal regulatory requirements, while collaborating with internal stakeholders and SMEs, and coordinating and assessing the impacts of program changes tied to QHP requests from the state and federal regulators. Creates a thorough understanding of contractual, regulatory and timing requirements for QHP products. The QHP & Business Support Manager also assists with and/or leads market analysis, competitive research, product/benefit and business support activities, as assigned.
Education:
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Five years or more related experience supporting responses to regulatory submission requirements, project management and/or market research analysis is acceptable in lieu of degree.
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BLD – Bachelor's Level Degree preferred
Certification/Licensure:
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None required
Experience:
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Project Management- 2 years experience REQUIRED
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Strategic Planning- 1 year experience REQUIRED
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Market Analysis- 2 years experience REQUIRED
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Intermediate proficiency in Excel (Pivot tables, SQL and Visual Basic) preferred
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Health Plan experience preferred
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Relevant in experience in Compliance/Audit/Regulatory and Operations (Enrollment, Claims) preferred
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-76580
#LI-PM1
#Indeed
Talroo – Health Plan
Keywords: Managed Care, MCO, Healthcare, Health Plan, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming, Virginia, North Carolina, Individual, Family Health Plans, Commercial, Exchange, Qualified Health Plan, Business Support, Project Manager, Compliance, Audit, Regulatory, Operations, Enrollment, Claims, Excel
Culture In Action
At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work are what make Sentara special and what allows us to deliver excellent service and care to our patients, members, and communities.
Sentara prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
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