RN Performance Monitor Specialist, Clinic

Centene Corporation

. Conduct clinical file assessments by reviewing assigned clinical documentation for required clinical adherence .

Posted 11/2/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical file assessments, ensuring adherence to clinical standards and regulations. Proficient in evaluating documentation and preparing for audits while maintaining productivity and interrater reliability.

Highest-signal resume keywords

Clinical File AssessmentManaged Care ExperienceLicensed Registered Nurse (RN)Certified Case Manager (CCM)Prior Authorization Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical Documentation ReviewHealth Assessment EvaluationIntervention AnalysisAudit PreparationProductivity Standards Compliance

Soft Skills

CommunicationCollaborationProblem-Solving

Certifications & Qualifications

Licensed Clinical Social Worker (LCSW)Licensed Mental Health Counselor (LMHC)Licensed Marital and Family Therapist (LMFT)

Industry Keywords

MedicareMedicaidClinical EnvironmentState ContractsNCQA Audits

About the role

Key responsibilities & impact

Conduct clinical file assessments by reviewing assigned clinical documentation for required clinical adherence
Participate in the development and ongoing review of clinical review tools
Review program descriptions, policies and procedures, step actions, training materials, and State Contracts as needed
Evaluate alignment of review tool elements, departmental processes, staff training, and contractual/departmental standards
Use clinical knowledge and experience to evaluate documentation of member health assessments, clinical needs, and interventions
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 by collecting and/or reviewing relevant clinical areas
Meet established productivity and interrater reliability standards for file reviews
Follow departmental guidelines, processes, policies, and standards
Perform other duties as assigned

Requirements

What you’ll need

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)
1+ year of experience in Managed Care (UM, BH, CM) preferred
Familiarity with Medicare and Medicaid programs preferred
A license in one of the following is required: Licensed Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or Licensed Marital and Family Therapist (LMFT)
Certified Case Manager (CCM) preferred
RN with UM experience
Prior Authorization experience highly preferred

Benefits

Comp & perks

Competitive pay
Health insurance
401K and 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
Equal opportunity employer committed to diversity