Clinical Development Consultant

🔥 1 hour ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $63.4k - $119.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Plan, direct, coordinate, execute, and evaluate educational programs supporting clinical staff and functions • Create and implement onboarding and training programs for clinical new hires • Develop and manage continuing education, training, and professional development initiatives • Partner with leadership on workflow development and maintenance for departmental teams • Ensure clinical staff compliance with regulatory and accreditation requirements through comprehensive training strategies • Manage clinical competency evaluations and continuing education related to clinical programs, best practices, policies, and procedures • Plan, organize, evaluate, and maintain orientation/onboarding processes • Communicate onboarding progress to leadership, recommend remediation, and document completion of orientation, competencies, and mandatory training • Mentor and assist clinical staff with continuing education and professional development opportunities • Align clinical educational content with regulations, accreditation standards, and organizational policies • Provide targeted education for regulatory audits, accreditation surveys, and corrective action plans • Identify training needs and develop educational materials based on audits, Inter-Rater Reliability Assessments, and quality findings • Provide individual and group consultation addressing performance gaps, documentation quality, and decision consistency • Recommend process and educational strategy improvements based on data and best practices • Facilitate TruCare program training for clinical staff • Attend required company and departmental meetings and training sessions

🎯 Requirements

• Active Registered Nurse licensure in Pennsylvania or Enhanced Nurse Licensure Compact (eNLC) multistate licensure in the home state • Bachelor’s degree in Nursing or higher required; bachelor’s degree in business, education, or a health-related field accepted • Minimum 5 years of Utilization Management experience in a health plan, managed care organization, or similar setting • Minimum 5 years’ experience in an acute care setting • Minimum 3 years of experience in education, training, coaching, or professional development • Strong organizational, problem-solving, documentation, and communication skills • Ability to translate complex regulations into practical, understandable training • Ability to manage multiple conflicting priorities in a fast-paced environment • High comfort with clinical documentation systems • Effective public speaking and written communication skills • Proficiency with Microsoft Office products • Knowledge of health plan principles and clinical best practices • Knowledge of adult learning principles, motivational interviewing, intrinsic coaching techniques, and education/training strategies • Experience supporting CMS, NCQA, or state regulatory audits • Experience developing educational content • Knowledge of clinical and managed care principles and operations • Ability to operate a personal computer • InterQual® certification strongly preferred or willingness to obtain when offered

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible environment • Training and continuing education • Professional and personal growth opportunities • Community volunteering opportunities