Clinical Trainer, Auditor – Utilization 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

• Design, deliver, and evaluate clinical training programs and audit activities for Utilization Management and Care Management • Develop training on clinical philosophy, evidence-based practice, documentation standards, regulatory requirements, and operational workflows • Assess training needs and evaluate effectiveness using feedback, knowledge checks, audit trends, and performance data • Coordinate onboarding and training readiness, including system access, resources, checklists, and technical issue resolution • Perform quality audits of Utilization Management activities, medical director determinations, Care Management, and Health Management documentation • Conduct inter-rater reliability assessments and support remediation and performance improvement initiatives • Facilitate calibration and standardization of clinical criteria, policies, workflows, and documentation expectations • Present case 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, guided practice, mock scenarios, competency checks, and follow-up coaching • Coordinate cross-functional support between IT, new hires, and operational teams • 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 for a behavioral health professional, RDN, or CDCES; OR active, current, and unrestricted RN license in Arizona or another NLC state; OR active, current, and unrestricted Arizona LPN license • Preferred: 5 years of experience in clinical education, training, auditing, quality improvement, and instructional design 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, staff development, remediation, or performance improvement for clinical staff • Preferred master's degree in nursing, social work, behavioral health, psychology, or related clinical field • Preferred certifications such as CCM, CPHQ, BCBA, or Utilization Management certification • Strong written and verbal communication, organizational, analytical, reporting, computer, and technology skills • Proficiency with Word, Excel, PowerPoint, SharePoint, Microsoft Teams/Webinar, and the Internet • Ability to understand workflows, create and implement integrated policies, procedures, workplans, and solutions • Ability to collaborate with stakeholders across multiple business areas and work independently • Knowledge of healthcare costs and quality challenges, patient education, behavior change techniques, Adult Learning Theory, managed care, utilization management, quality management, and CPT/HCPCS and ICD-10 coding • Ability to maintain confidentiality and privacy, prioritize multiple tasks, exercise sound judgment, and solve problems • Ability to professionally represent AZ Blue in the community

🏖️ Benefits

• Remote work arrangement with no regular onsite requirements • Full-time schedule of at least 40 hours per week • Continuing education participation • Training and professional development opportunities • Work supporting more than one million Arizonans • Health insurance products and services provided by the employer