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Program Monitor
Career Insights for Clinical Auditor / Utilization Reviewer
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Scorecard
Based on Massachusetts data
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What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$104,154 / year median in Massachusetts
-6% projected decline
Job Description
Overview Job Summary Under the general direction of the department Director or designee, the Program Monitor is responsible for the quality assurance activities of assigned service delivery programs within Disability and Community Services (DCS). This position will execute internal assurance reviews and recommend corrective action plans to resolve deficiencies. The program monitor will participate in continuous quality improvement projects as needed. This position will develop and deliver reports outlining audit findings to the Director and Associate Director of each DCS program. Responsibilities Major Responsibilities Develop the performance measures and methodologies consistent with the program and state agencies' goals to monitor internal and subcontractor performance with contract terms Conduct routine audits and reviews of DCS clinical and operational work products Participate in continuous quality improvement projects as determined by contract terms Identify deficiencies in performance, and support the Director and Associate Directors in implementing a corrective action plan with input from key subcontractor, program personnel, and departmental management personnel to resolve deficiencies Develop and prepare clearly written reports summarizing monitoring activities Assist in the development and revision of contract scopes of service Act collaboratively as a liaison to departmental staff for implementation and follow-up of corrective action activities Develop and implement monitoring and training work plans, and preparation of deliverables Write and/or make recommendations for new programmatic policies and procedures and oversee their implementation Comply with all safety and infection control standards specific to the work site, as applicable Perform other duties as required. Qualifications Required Qualifications Bachelor's Level Degree in nursing, social work, rehabilitation counseling, occupational therapy, or a related field 5 - 7 years providing direct service in human services, knowledge and experience with clinical, social service/human service/rehabilitation systems Knowledgeable of applicable state and federal laws and regulations governing the provision of services for adults with developmental disabilities, mental retardation, and/or other disabilities, and/or individuals with medically complex care needs. Proficient with Word, Excel, and other desktop tools Preferred Qualifications Master's Level Degree Prior experience developing quality assurance programs