Performance Monitor Specialist, Clinic

Location: Remote-FL

Salary: $56,200–$101,000 per year

Company

hirify.global provides healthcare services focused on improving access to care for individuals, families, and communities.

What you will do

• Conduct clinical file assessments by reviewing member health assessments, clinical documentation, care needs, interventions, call recordings, and related records.
• Evaluate adherence to organizational policies, contractual requirements, Model of Care standards, and clinical performance criteria.
• Develop and continuously review clinical review tools to ensure review elements accurately capture required standards.
• Review policies, procedures, program descriptions, training materials, and state contracts to validate alignment between processes, training, and contractual requirements.
• Discuss findings and improvement recommendations, escalate concerns, and participate in interrater reliability meetings.
• Support preparation for State, CMS, and NCQA audits while meeting productivity and review-quality standards.

Requirements

• Bachelor's degree in Nursing, Clinical Social Work, or Counseling, or an associate degree with an RN license and 3+ years of clinical experience.
• At least 3 years of experience in an inpatient or outpatient clinical environment.
• Active license as a Registered Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor, or Licensed Marital and Family Therapist.
• Strong attention to detail and experience evaluating clinical documentation and call quality.
• Remote work location: Florida.

Nice to have

• At least 1 year of experience in managed care, including utilization management, behavioral health, or case management.
• Familiarity with Medicare and Medicaid programs.
• Certified Case Manager certification.

Culture & Benefits

• Health insurance and paid time off plus holidays.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Flexible work arrangements, including remote, hybrid, field, or office schedules.
• Equal opportunity workplace with consideration for qualified applicants regardless of protected characteristics or applicable records.