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Clinical Practice Analyst in Southwest Virginia (Bristol, Roanoke)
4 days agoWhat's your preference?
Job Description
- Req#: JR-93864
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely 4 days a week, with 1 day in-person visiting providers in Southwest Virginia
- Comprehensive benefits package including medical, dental, vision, and 401k/403B with employer match
- Tuition assistance of $5,250 per year and reimbursement for certifications
- Annual discretionary bonus opportunity based on eligibility criteria
- Supportive and family-friendly work culture that encourages community involvement
What to Expect (Job Responsibilities):
- Conduct detailed reviews of clinical documentation for accuracy and compliance with regulations
- Assess medical necessity and scope 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 educational initiatives
What is Required (Qualifications):
- MLD - Master's Level Degree in a relevant field
- Active clinical licensure in the state of Virginia as an LPN, RN, or LCSW
- Minimum of three (3) years of professional experience in a relevant role
- 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 regulatory requirements
How to Stand Out (Preferred Qualifications):
- Experience with clinical regulatory requirements and accreditation processes
- Familiarity with managed care organizations and health plan operations
#HealthcareServices #ClinicalPractice #RemoteWork #CareerGrowth #HealthcareCareersAbout the company
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