Performance Monitor Specialist, Clinic
Core
Audits care management member interactions by reviewing call recordings and clinical documentation to ensure compliance with organizational policies and contractual requirements.
Role type
Senior IC clinical auditor (nursing/social work)
Builds
Clinical review tools and adherence reports for managed care programs
Domain
Healthcare / Managed Care / Behavioral Health
Required skills
Clinical file assessment, Call quality evaluation, Clinical documentation review, Compliance auditing, Policy interpretation, State contract alignment, Audit preparation, IRR participation
Preferred skills
Managed care experience (UM, BH, CM), Medicare/Medicaid familiarity, Case management background
Technologies
Call recording systems, Clinical review tools, State contract databases
Responsibilities
Conduct clinical file assessments for adherence, Develop and review clinical review tools, Evaluate member health assessments and interventions, Participate in improvement meetings, Escalate areas of concern, Prepare for state/CMS/NCQA audits
Seniority
Mid-level, hands-on IC
