Clinical Trainer & Auditor - Remote AZ

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

The Clinical Trainer and Auditor is responsible for planning, developing, delivering, coordinating, and evaluating a variety of clinical education programs for health plan clinical operations staff. Training programs include but aren’t limited to that required for NCQA accreditation, New Hire Orientation, Annual Training, Model of Care Training, and CMS and AHCCCS requirements.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years’ experience in clinical care

• 2 years of work experience in a managed care setting

• Prior experience in NCQA Surveys, CMS Program Audit, and/or AHCCCS Operational Review

• Prior audit experience

Required Education

• Bachelor degree in Nursing

Required License

• Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN within the first 60 days of hire.

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 5 years’ experience in clinical care

• Physical and behavioral health experience

• 2 years’ experience in a training role

• 5 years’ experience working in a managed care organization

• Training program development

• Knowledge of population health concepts and models

• Knowledge of medical and care management models

• Knowledge of IRR process

Preferred Education

• Master’s Degree in Nursing

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Consults with clinical operations leaders to identify, develop, and respond to training needs and requests Develops curriculum, maintains currency, and revises as appropriate Plan, coordinate, deliver, and evaluate clinical training for clinical operations programs, including:

• New hire onboarding

• Annual Training

• Customer service excellence

• Quality and performance metrics

• Ongoing professional growth, compliance, and regulatory training

• Serve as a resource for staff in areas of clinical practice, clinical professional development, using coaching, mentoring, effective feedback, and motivation support techniques

• Serve as subject matter expert on policies and procedures, and desktop procedures related to NCQA, CMS, and AHCCCS requirements

• Utilize a variety of the training methodologies, techniques, concepts, learning tools, and practices

• Provide online and conference call training session for remote employees

• Develop valid exercises designed to provide effective hands-on practice to new and existing employees

• Monitor and report on the effectiveness of education/training programs

• Create and develop training for employees not able to meet or maintain standards of excellence

• Develops audit tools that meet NCQA, CMS, and AHCCCS requirements

• Perform case reviews/audits and IRR analysis, according to standards

• Audits staff phone calls and written documentation according to policy

• Conducts periodic audits of documents such as HRA, ETI, Assessments, Care Plans, Medical Necessity Documentation to ensure compliance

• Provide documentation of staff training according to accreditation and regulatory requirements

• Collaborate with BCBSAZ Training and Workforce Development department

• Participate in continuing education and current developments in the field of accreditation, medicine, behavioral health, social determinants of health, and managed care at least annually.

• 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 duties as assigned

• Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies

• Assist manager with policy and practice guideline development and revisions as well as necessary coaching to help each staff member reach personal, professional and department goals

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

• Intermediate PC proficiency: Intermediate skill in word processing, spreadsheet, and database software

• Excellent communication, collaboration, and training skills.

• Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames

• Ability to learn new applications

Required Professional Competencies

• Knowledge of NCQA, CMS, and AHCCCS Standards

• Demonstrates knowledge of accreditation, regulatory, and certification requirements
• Current clinical knowledge

• Collaborates with Information Technology to maximize the utilization of the medical management system (CareRadius) and technologies to support compliance

• Interpret and translate policies, procedures, programs and guidelines

• Communicate outcomes to leadership

• Understand and interpret data to effectively create curriculum based on needs identified

PREFERRED COMPETENCIES

Preferred Job Skills

• Advanced PC proficiency

• Advanced processing, spreadsheet and presentation software proficiency

• Detail Oriented

• Results driven

• Strong organizational skills

Preferred Professional Competencies

• Uses formal instructional design methodology to develop and support sophisticated, complex and/or enterprise-wide, competency-based training, skills, and education

Preferred Leadership Experience and Competencies

• Demonstrated skills and competence in training methods

• Demonstrates effective presentation skills

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

Originally posted on Himalayas