Key skills
Leadership
About this role
Role Overview
- 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.
Requirements
- MLD
- Master's Level Degree
- 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.
- 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