Clinical Practice Analyst- Virginia Beach, VA

Sentara Health • Virginia Beach, VA

8d • Hybrid

About The Position

Sentara Health Plans is hiring a Clinical Practice Analyst- RN/LPC/LCSW - Virginia Beach, VA! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: Candidate must be located in Virginia Beach, VA. This position will work remotely 4 days per week and 1 day per week visiting providers in Virginia Beach, VA. In-person meetings may be required as needed at the closest office or an agreed-upon location. Job responsibilities: As a Clinical Practice Analyst, you will play a key role in ensuring the integrity and effectiveness of clinical services across multiple lines of business. This position is responsible for conducting comprehensive reviews of clinical documentation, evaluating medical necessity, and monitoring provider compliance with regulatory and contractual standards. Analysts may present findings and recommendations to internal committees and leadership, supporting data-driven decisions that improve care delivery and operational performance.

Requirements

• BLD - Bachelor's Level Degree OR MLD - Master's Level Degree- Social Work REQUIRED
• Candidate must have active clinical licensure in the state of Virginia. LPN or RN. Social work candidates required to have active social work licensure - LCSW. Counselor candidates must have appropriate and active licensure LPC. Virginia state requirements for licensure must be met and maintained.
• A minimum of three (3) years of professional experience REQUIRED
• At least one (1) year of quality, regulatory, compliance, accreditation, and/or auditing experience.

Nice To Haves

• Knowledge of clinical regulatory requirements, experience with CMS and state regulatory and accreditation requirements preferred.

Responsibilities

• Conduct detailed reviews of clinical documentation for accuracy, completeness, and compliance with state and federal 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 as needed.
• Collaborate with providers to implement corrective actions and education initiatives.
• Contribute to performance monitoring and reporting to support continuous improvement efforts.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees