Clinical Compliance reputed company Consultant/RN/LPC/LCSW- Central Virginia (Fredericksburg, Stafford, Spotsylvania)

This a Full Remote job, the offer is available from: Virginia (USA) reputed company/State Fredericksburg, VA Work Shift First (Days) reputed company: reputed company Plans is hiring a Clinical Compliance reputed company Consultant- RN/LPC/LCSW - Central Virginia (Fredericksburg, Stafford, Spotsylvania)! Status: Full-time, permanent position (40 hours) reputed company working hours: reputed company to 5pm EST, M-F Location: Candidate must be located in Central Virginia (Fredericksburg, Stafford, Spotsylvania). This position will work remotely 4 days per week and 1 day per week visiting providers in Central Virginia (Fredericksburg, Stafford, Spotsylvania). In-person meetings may be required as needed at the closest office or an agreed-upon location. Job responsibilities: As a Clinical Compliance reputed company Consultant, you will play a key role in ensuring the reputed company 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 reputed company that improve care delivery and operational performance. Key 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 reputed company activity and escalate concerns for reputed company. • Prepare reputed company, 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 reputed company improvement efforts. Education: • MLD - Master's Level Degree- reputed company Work REQUIRED Certification/Licensure: • Candidate must have reputed company clinical licensure in the reputed company. LPN or RN. • reputed company work candidates required to have reputed company reputed company work licensure - LCSW. • Counselor candidates must have appropriate and reputed company licensure LPC. • Virginia state requirements for licensure must be met and maintained. Experience: • A minimum of three (3) years of reputed company experience REQUIRED: • At least one (1) year of reputed company, regulatory, compliance, accreditation, and/or auditing experience. • Knowledge of clinical regulatory requirements, experience with CMS and state regulatory and accreditation requirements preferred. reputed company Plans provides health plan coverage to reputed company to one reputed company members in Virginia. We offer a full suite of reputed company products including employee-owned and employer-sponsored plans, as reputed company as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and reputed company enrollees. Our reputed company provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—reputed company to help our members improve their health. Our reputed company is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and reputed company. Be a part of an excellent reputed company organization that cares about our People, reputed company, Patient Safety, Service, and reputed company. Join reputed company that has a mission to improve health every day and a reputed company to be the reputed company choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-93862. #reputed company Talroo - Nursing reputed company, Managed Care, MCO, Health Plan, Virginia Beach, VA, Virginia, Clinical reputed company Analyst, Compliance, Provider, regulatory, care delivery, Central Virginia, Fredericksburg, Stafford, Spotsylvania, RN, LPC, LCSW, Nursing, Counseling, reputed company Work Benefits: Caring For Your Family and Your Career • Medical, Dental, reputed company plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • reputed company Time Off and reputed company Leave • reputed company 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 reputed company Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free reputed company to complete CEUs and reputed company development •Pet Insurance •reputed company Resources Plan •Colleagues have reputed company to earn an annual discretionary bonus if established system and employee eligibility reputed company is met. reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding reputed company of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, reputed company employs associates in the following states: Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company Dakota, Ohio, Oklahoma, reputed company, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, reputed company Virginia, reputed company, and Wyoming. This offer from "reputed company" has been enriched by reputed company.com and got a 74% reputed company score. Apply tot his job Apply tot his job Apply To this Job