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Clinical Practice Analyst- Virginia Beach, VA
6 days agoWhat's your preference?
Job Description
- Req#: JR-91725
Employer Industry: Healthcare Managed Care
Why consider this job opportunity:
- Full-time, permanent position with a standard work schedule of 8 AM to 5 PM EST, Monday to Friday
- Opportunity for career advancement and growth within the organization
- Work remotely 4 days a week, with 1 day required for in-person meetings in Virginia Beach, VA
- Comprehensive benefits including medical, dental, vision, and a 401k plan with employer match
- Annual discretionary bonus opportunity based on eligibility criteria
- Supportive and family-friendly 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 outlier activity patterns and escalate concerns for resolution
- Prepare actionable reports and present findings to internal committees or leadership
- Collaborate with providers to implement corrective actions and education initiatives
What is Required (Qualifications):
- Bachelor's Level Degree or Master's Level Degree in Social Work
- Active clinical licensure in the state of Virginia (LPN, RN, LCSW, or LPC)
- Minimum of three (3) years of professional experience in a related field
- At least one (1) year of experience in quality, regulatory, compliance, accreditation, or auditing
- Knowledge of clinical regulatory requirements, with experience in CMS and state regulations preferred
How to Stand Out (Preferred Qualifications):
- Experience with compliance and regulatory standards in healthcare settings
- Familiarity with accreditation processes and requirements
- Strong analytical and critical thinking skills
- Excellent communication and presentation abilities
- Ability to work collaboratively in a team-oriented environment
#Healthcare #ManagedCare #ClinicalPracticeAnalyst #CareerOpportunity #RemoteWork
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