Performance Monitor Specialist

🔥 16 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Conduct clinical file assessments by reviewing clinical documentation for required clinical adherence • Audit care management member interactions by reviewing call recordings and related documentation • Participate in the development and ongoing review of clinical review tools • Review program descriptions, policies and procedures, step actions, training materials, and State Contracts to evaluate alignment with standards • Evaluate documentation of member health assessments, clinical needs, and interventions against compliance standards • Participate in meetings to discuss review findings, areas of opportunity, and recommendations for improvement • Escalate areas of concern identified during clinical file reviews • Assist with preparation for State, CMS, and NCQA audits • Meet established productivity and Interrater Reliability standards for file reviews • Follow departmental guidelines and processes • Perform other duties as assigned

🎯 Requirements

• Bachelor's Degree in Nursing, Clinical Social Work/Counseling required OR Associate's degree and an RN with 3+ years of clinical experience • 3+ years of experience in a clinical environment (inpatient or outpatient) • License required as a Licensed Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or Licensed Marital and Family Therapist (LMFT) • 1+ year of experience in Managed Care (UM, BH, CM) preferred • Familiarity with Medicare and Medicaid programs preferred • Certified Case Manager (CCM) preferred • Excellent attention to detail • Experience evaluating clinical documentation and call quality

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation