Clinical Trainer & Auditor - Remote AZ

Clinical Trainer And Auditor

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.

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 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 (Care Radius) 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

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.