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.

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 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

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