Clinical Trainer & Auditor

Job Summary

Plans, develops, delivers, coordinates, and evaluates clinical education programs for health plan clinical operations staff. Training includes new-hire orientation, annual training, model of care training, accreditation preparation, and regulatory requirements.

• Consult with clinical operations leaders to identify and address training needs.
• Develop, maintain, and revise training curricula.
• Plan, coordinate, deliver, and evaluate clinical training programs, including onboarding, annual training, customer service, quality and performance metrics, professional development, compliance, and regulatory training.
• Serve as a resource for clinical practice and professional development through coaching, mentoring, feedback, and motivation.
• Serve as a subject matter expert on policies, procedures, and operational requirements related to accreditation and regulatory standards.
• Use varied training methodologies, instructional techniques, learning tools, and practices.
• Provide online and conference-call training for remote employees.
• Develop practical exercises that provide effective hands-on learning for new and existing employees.
• Monitor and report on the effectiveness of education and training programs.
• Create targeted training for employees who do not meet or maintain performance standards.
• Develop audit tools that meet applicable accreditation and regulatory requirements.
• Perform case reviews, audits, and inter-rater reliability analyses according to established standards.
• Audit staff phone calls and written documentation according to policy.
• Conduct periodic audits of health risk assessments, evaluations, care assessments, care plans, and medical necessity documentation to ensure compliance.
• Maintain documentation of staff training according to accreditation and regulatory requirements.
• Collaborate with training and workforce development teams.
• Participate in continuing education and remain current in accreditation, medicine, behavioral health, social determinants of health, and managed care.
• Perform other duties as assigned.
• Maintain thorough knowledge of medical coverage guidelines and organizational policies.
• Assist with policy and practice guideline development and revisions, and provide coaching to support individual and departmental goals.
• Comply with applicable organizational policies, procedures, privacy requirements, accreditation standards, and quality management expectations.

• At least three years of clinical care experience.
• At least two years of experience in a managed care setting.
• Experience with accreditation surveys, regulatory program audits, operational reviews, and clinical audits.
• Bachelor s degree in nursing.
• Active, current, unrestricted licensure as a registered nurse or qualified behavioral health professional.
• Ability to obtain or maintain any required professional credentials.

• Clinical training and education experience.
• Knowledge of accreditation, regulatory, and certification requirements.
• Experience developing curricula, training programs, and audit tools.
• Strong clinical knowledge and understanding of medical and behavioral health operations.
• Ability to interpret policies, procedures, programs, guidelines, and data.
• Strong communication, collaboration, presentation, coaching, and mentoring skills.
• Ability to manage multiple priorities and meet deadlines.
• Strong analytical, organizational, and problem-solving skills.

• Intermediate proficiency with word-processing, spreadsheet, database, and presentation software.
• Ability to learn and use new applications and technology.
• Ability to collaborate with information technology teams to support compliance and system utilization.
• Ability to communicate outcomes and recommendations to leadership.
• Preferred advanced computer proficiency.
• Preferred experience with formal instructional design methodologies and competency-based training.
• Preferred experience developing complex or enterprise-wide training programs.
• Detail-oriented, results-driven, and highly organized.
• Effective presentation and instructional skills.