Clinical Trainer, Auditor – Case Management Experience

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Blue Cross Blue Shield of Arizona

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Blue Cross Blue Shield of Arizona is a health insurance provider offering a variety of health plans tailored to individuals, families, employers, and Medicare recipients. With a commitment to improving healthcare access and community health, AZ Blue provides self-insured and ACA-compliant health plans, including Medicare Advantage and Medicaid options. The organization focuses on connecting members with care through its extensive network, aiming for better health outcomes and community support.

📋 Description

• Develop and deliver clinical training and education for clinical staff across Utilization Management, Care Management, and Health Management • Assess and prioritize training needs based on workflow changes, audit findings, stakeholder feedback, business priorities, and staff readiness • Evaluate training effectiveness using feedback, knowledge checks, audit trends, and performance data • Assist with performance goals, quality management activities, and improvement initiatives • Coordinate onboarding and training readiness, including system access, resources, checklists, and technical barriers • Perform quality audits of Utilization Management activities and medical director determinations, including inter-rater reliability assessments • Audit Care Management and Health Management documentation for accuracy, completeness, care-plan alignment, and member outcomes • Support targeted education, remediation, and performance improvement based on audit findings • Facilitate calibration and standardization of clinical criteria, policies, workflows, and documentation expectations • Present case status updates and findings to managers, supervisors, and medical directors • Review and maintain policies, procedures, training materials, job aids, facilitator guides, and workflow resources • Facilitate hands-on technical training for CM, HM, and UM workflows, including system navigation, authorization entry, assessments, mock scenarios, and guided practice • Coordinate cross-functional support between IT, new hires, and operational teams to resolve system access and application issues • Maintain compliance with state, federal, AZ Blue, URAC, CMS, and other regulatory and accreditation standards

🎯 Requirements

• 5 years of direct clinical care experience in a healthcare setting • 2 years of experience in Utilization Management, Care Management, Health Management, Disease Management, or other managed care operations • 4 years of experience in clinical training, education, auditing, or quality improvement, preferably in managed care • Associate degree in a general field of study or post-high-school nursing diploma • Active, current, and unrestricted Arizona license or endorsement to practice as a behavioral health professional, RDN, or CDCES; alternatively, an active, current, and unrestricted RN license in Arizona or another NLC state, or an active, current, and unrestricted Arizona LPN license • Strong written and verbal communication skills • Proficient computer and technology skills, especially Word, Excel, PowerPoint, SharePoint, Microsoft Teams/Webinar, and Internet • Ability to gather and analyze data and prepare accurate reports • Ability to understand workflows across multiple company components and help create and implement integrated policies, procedures, workplans, and solutions • Knowledge of health or patient education and behavior-change techniques • Advanced knowledge of Adult Learning Theory and ability to facilitate training for varied learning styles • Ability to analyze, interpret, synthesize, evaluate, and explain educational concepts and methodologies • Ability to maintain confidentiality and privacy • Strong interpersonal, active listening, organizational, prioritization, collaboration, judgment, and problem-solving skills • Preferred: 5 years of clinical education, training, auditing, quality improvement, and instructional design experience in Utilization Management or Case Management • Preferred: 1 year of experience with Milliman Care Guidelines (MCG) or other clinical criteria/guidelines • Preferred: experience conducting clinical audits, quality reviews, or inter-rater reliability assessments • Preferred: experience supporting onboarding, remediation, or performance improvement for clinical staff • Preferred: master’s degree in nursing, social work, behavioral health, psychology, or related clinical field • Preferred: CCM, CPHQ, BCBA, or utilization management certification • Preferred: advanced PC proficiency and knowledge of CPT/HCPCS and ICD-10 coding • Preferred: knowledge of managed care, utilization management, and quality management

🏖️ Benefits

• Remote work arrangement with no regular onsite requirement • Full-time schedule of at least 40 hours per week • Continuing education opportunities • Training and professional development through onboarding, education, coaching, and staff development initiatives