RN Performance Monitor Specialist, Clinic

Position Purpose: Responsible for clinical file assessments. Identifies monthly insights for improvement and participates in Interrater Reliability meetings. Aids in efforts to continuously develop review tools to ensure validity of criteria, and appropriately captures evidence of expected clinical performance within contractual and Model of Care standards. Key Details : This role is looking for RN's with UM experience; Prior Authorization experience highly preferred. Conducts clinical file assessments by reviewing clinical documentation as assigned for required clinical adherence. Participates in the development and ongoing review of clinical review tool to ensure that clinical elements accurately capture adherence with required performance standards.…