Clinical Trainer and Auditor - Remote AZ

Requirements

• REQUIRED QUALIFICATIONS
• Required Work Experience
• 5 years of direct clinical care experience in a healthcare setting
• 2 years of work experience in a managed care setting
• 4 years of clinical training or clinical education experience, preferably in managed care.
• Required Education
• Associate Degree or in Nursing
• Required Licenses Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN) or Master's in Social Work (MSW).
• Required Certifications N/A
• Preferred Work Experience 5 years of experience in clinical education, training and instructional design.
• 1 year of experience working with Milliman Care Guidelines (MCG), InterQual and/or other clinical criteria/guidelines.
• Preferred Education Bachelor's Degree in Nursing or Master's Degree in Nursing
• Preferred Certifications Active and current certifications in the following certifications: Certified Case Manager (CCM) or Utilization Management Certification
• Preferred Certifications N/A
• ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
• Develop and educate clinical staff on the company's clinical philosophy and evidence based practice methods required for excellent patient outcomes and regulatory requirements for care management and utilization management.
• Identify training needs outside of core curriculum to promote maximized effectiveness in managing medical costs and improving clinical outcomes.
• Maintain and monitor the delivery and effectiveness of the training programs, identify solutions to challenges and implement improvements.
• Assist with the development and evaluation of performance goals and objectives and quality management activities.
• Develop and facilitate new hire orientation for the clinical staff and ensure transition of training into daily work activities related to clinical practice, patient safety and evidence-based practice.
• Performs quality audits and facilitates inter-rater reliability assessments to ensure standardization and consistency with clinical decisions.
• Support and provide education with process improvement programs and technical applications.
• Develop programs to support educational needs as determined by management.
• Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
• Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
• Maintain complete and accurate records per department policy.
• Participate in continuing education and current development in the field of medicine and managed care.
• Facilitate interdisciplinary care round/discussions under the direction of the VP, Clinical Benefit Management and/or delegate.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other

Benefits

Additional Information

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. PURPOSE OF THE JOB Responsible for developing and delivering clinical curriculum, developmental programs and services to assist with achievement of goals and initiatives. Responsible for conducting clinical audits and reviews to ensure standardization and consistency with nurse reviewer clinical decisions.

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