Sentara Health · 3 days ago
Clinical Practice Analyst- Virginia Beach, VA
Virginia Beach, VA
Full-time
Hybrid
Mid Level
3+ years expSentara Health Plans is hiring a Clinical Practice Analyst to ensure the integrity and effectiveness of clinical services. This role involves conducting comprehensive reviews of clinical documentation, evaluating medical necessity, and monitoring provider compliance with regulatory standards.
Hospital & Health Care
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
Qualification
Required
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
Preferred
Knowledge of clinical regulatory requirements, experience with CMS and state regulatory and accreditation requirements preferred
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.
Company
Sentara Health
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dennis Matheis
President & CEO
Howard Kern
CEO Emeritus Sentara Health
Recent News
2025-09-17
The Virginian-Pilot
2025-07-24
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