Clinical Trainer, Auditor

🕒 July 29

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 50%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Plan, develop, deliver, coordinate, and evaluate clinical education programs for health plan clinical operations staff • Develop curriculum, maintain currency, and revise training materials • Plan, coordinate, deliver, and evaluate new hire onboarding, annual training, customer service excellence, quality and performance metrics, professional growth, compliance, and regulatory training • Consult with clinical operations leaders to identify and respond to training needs • Serve as a resource on clinical practice and professional development through coaching, mentoring, feedback, and motivation • Serve as subject matter expert on NCQA, CMS, and AHCCCS policies, procedures, and desktop procedures • Use varied training methodologies, techniques, learning tools, and practices • Provide online and conference-call training for remote employees • Develop hands-on practice exercises for new and existing employees • Monitor and report education and training program effectiveness • Create training for employees unable to meet or maintain standards of excellence • Develop audit tools meeting NCQA, CMS, and AHCCCS requirements • Perform case reviews, audits, and IRR analysis • Audit staff phone calls and written documentation • Conduct periodic audits of HRA, ETI, assessments, care plans, and medical necessity documentation • Document staff training according to accreditation and regulatory requirements • Collaborate with BCBSAZ Training and Workforce Development • Participate annually in continuing education and developments in accreditation, medicine, behavioral health, social determinants of health, and managed care • Maintain knowledge of BCBSAZ medical coverage guidelines and policies • Assist with policy and practice guideline development and revisions and coach staff toward goals • Perform other assigned duties

🎯 Requirements

• 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 • Bachelor degree in Nursing • Active, current, and unrestricted Arizona license (or endorsement) to practice 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 RN license in Arizona or another NLC state recognized by the Nursing Licensure Compact, obtained within the first 60 days of hire • Intermediate PC proficiency in word processing, spreadsheet, and database software • Excellent communication, collaboration, and training skills • Ability to manage multiple tasks, prioritize work, and meet deadlines • Ability to learn new applications • Knowledge of NCQA, CMS, and AHCCCS standards • Knowledge of accreditation, regulatory, and certification requirements • Current clinical knowledge • Ability to collaborate with Information Technology on CareRadius and compliance technologies • Ability to interpret and translate policies, procedures, programs, and guidelines • Ability to communicate outcomes to leadership • Ability to interpret data and create curriculum based on identified needs • Preferred: 5 years’ experience in clinical care • Preferred: Physical and behavioral health experience • Preferred: 2 years’ experience in a training role • Preferred: 5 years’ experience working in a managed care organization • Preferred: Training program development • Preferred: Knowledge of population health concepts and models • Preferred: Knowledge of medical and care management models • Preferred: Knowledge of IRR process • Preferred: Master’s Degree in Nursing • Preferred advanced PC, processing, spreadsheet, and presentation software proficiency • Preferred formal instructional design methodology experience

🏖️ Benefits

• Hybrid workforce strategy offering flexibility with how and where employees work • Remote work opportunity • Full-time employment schedule of at least 40 hours per week • Continuing education and professional development • Coaching, mentoring, effective feedback, and motivation support • Training and Workforce Development collaboration • Health insurance products and services (company offering context)