Serves as the clinical point of contact for providers and primary care practices for orientation, on-going training, and support for the practice's clinical coordination and care management team regarding company clinical programs and case management concepts
Conducts clinical review meetings with physician office staff and internal staff
Works in collaboration with the PC2 team on program review, evaluation and program design enhancements
Serves as the subject matter expert for primary care practices on all Care Management programs for all lines of business and care management programs (i.e., CM, DM, Senior, Nurse Line)
Partners with case/disease management departments to facilitate clinical processes between the company and provider offices
Serves as a liaison with state/region provider contracting account managers and other associates

Requires BA/BS in Nursing
minimum of 5 years of medical management experience
Current unrestricted RN license required
MS or advanced degree preferred
1 year experience in quality and/or risk management
Experience conducting mandated facility site reviews and medical record audits highly preferred
Highly proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Experienced with Electronic Health Records (EHR)
Knowledgeable in medical terminology

Provider Clinical Liaison, Nurse Auditor

Key skills