Sentara Healthcare
Clinical Practice Analyst in Central Virginia (Richmond, Chesterfield, Petersburg)
5 days agoWhat's your preference?
Job Description
- Req#: JR-93863
Employer Industry: Healthcare Managed Care
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely 4 days per week with one day of in-person meetings in Central Virginia
- Comprehensive benefits package including medical, dental, vision plans, and more
- Tuition assistance of up to $5,250 per year and reimbursement for certifications
- Potential for an annual discretionary bonus based on eligibility criteria
- Supportive work environment prioritizing community involvement and employee development
What to Expect (Job Responsibilities):
- Conduct detailed reviews of clinical documentation for accuracy, completeness, and compliance with regulations
- Assess medical necessity, scope, and duration of services against established guidelines
- Identify patterns of outlier activity and escalate concerns for resolution
- Prepare clear, actionable reports and present findings to internal committees or leadership
- Collaborate with providers to implement corrective actions and education initiatives
What is Required (Qualifications):
- Must have a Master's Level Degree (MLD)
- Active clinical licensure in the state of Virginia as an LPN, RN, LCSW, or LPC
- Minimum of three (3) years of professional experience required
- At least one (1) year of experience in quality, regulatory, compliance, accreditation, and/or auditing
- Knowledge of clinical regulatory requirements and experience with CMS and state requirements preferred
How to Stand Out (Preferred Qualifications):
- Experience with clinical regulatory requirements and familiarity with CMS and state regulatory and accreditation standards
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Sentara Healthcare is a not-for-profit healthcare organization serving Virginia and northeastern North Carolina.
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