Clinical Nurse Educator, Consultant

Your Role

The Enterprise Learning team is responsible for all new hire and existing staff technical and clinical education for multiple departments within Medical Care Solutions and Health Care Quality and Affordability. This includes Utilization Management, Case Management, Population Health Management, Post Service, and Appeals & Grievances. The Utilization Management Clinical Educator position will report to the Senior Stakeholder Manager in Enterprise Learning.

In this role you will be supporting the following:
Clinical education programs for new and existing staff supporting Utilization Management. Partner with Utilization Management operational departments to develop clinical training modules for Utilization Management clinical reviews for all lines of business.

• Bachelor's degree or equivalent experience, required
• Current and unrestricted California RN license, required
• Minimum 7 years of prior relevant clinical experience, required
• Experience working in an acute care clinical setting, preferred
• Experience working for a Health Payer in Utilization Management, preferred
• Knowledge of MCG guidelines, medical policies, and Utilization Management clinical criteria, preferred
• Knowledge of regulatory agencies DMHC, NCQA, CMA, and DHCS regulatory agencies, preferred
• Experience educating and training clinicians, preferred
• Experience developing clinical training programs, preferred
• Experience with navigating multiple systems/resources simultaneously