Clinical Trainer, Auditor – Case Management Experience

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Design and implement clinical training and education programs for clinical personnel within Utilization Management, Care Management, and Health Management.

• Identify and prioritize training requirements based on changes in workflow, audit results, stakeholder input, business objectives, and staff readiness.

• Assess the effectiveness of training programs through participant feedback, knowledge evaluations, audit patterns, and performance metrics.

• Contribute to performance objectives, quality management efforts, and enhancement initiatives.

• Oversee onboarding and training preparedness, which includes system access, resource allocation, checklists, and troubleshooting technical challenges.

• Conduct quality audits of Utilization Management functions and medical director decisions, including assessments of inter-rater reliability.

• Review Care Management and Health Management documentation for accuracy, completeness, alignment with care plans, and member outcomes.

• Provide targeted education, remediation, and performance enhancement based on findings from audits.

• Lead the calibration and standardization of clinical criteria, policies, workflows, and documentation standards.

• Report case status updates and findings to managers, supervisors, and medical directors.

• Update and manage policies, procedures, training documents, job aids, facilitator guides, and workflow resources.

• Deliver hands-on technical training for CM, HM, and UM workflows, which includes system navigation, authorization processes, assessments, mock scenarios, and guided practice.

• Facilitate cooperation between IT, new employees, and operational teams to address system access and application challenges.

• Ensure compliance with state and federal regulations, AZ Blue, URAC, CMS, and other relevant accreditation standards.

⛳️ Requirements

• A minimum of 5 years of direct clinical care experience in a healthcare environment.

• At least 2 years of experience in Utilization Management, Care Management, Health Management, Disease Management, or other managed care functions.

• A minimum of 4 years of experience in clinical training, education, auditing, or quality improvement, ideally in managed care settings.

• An associate degree in a general field or a post-high-school nursing diploma.

• An active, current, and unrestricted Arizona license or endorsement to practice as a behavioral health professional, RDN, or CDCES; alternatively, a current and unrestricted RN license in Arizona or another NLC state, or an active and unrestricted Arizona LPN license.

• Exceptional written and verbal communication abilities.

• Strong computer and technology skills, particularly in Word, Excel, PowerPoint, SharePoint, Microsoft Teams/Webinar, and Internet applications.

• Capability to gather and analyze data and produce accurate reports.

• Understanding of workflows across various organizational components and the ability to assist in the creation and implementation of integrated policies, procedures, work plans, and solutions.

• Familiarity with health or patient education and behavior-change strategies.

• Advanced knowledge of Adult Learning Theory and the capacity to facilitate training for diverse learning preferences.

• Proficiency in analyzing, interpreting, synthesizing, evaluating, and explaining educational concepts and methodologies.

• Ability to maintain confidentiality and uphold privacy standards.

• Strong interpersonal skills, active listening, organizational capabilities, prioritization, collaboration, judgment, and problem-solving skills.

• Preferred: 5 years of experience in clinical education, training, auditing, quality improvement, and instructional design within 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 aiding onboarding, remediation, or performance improvement for clinical staff.

• Preferred: master’s degree in nursing, social work, behavioral health, psychology, or a related clinical field.

• Preferred: certifications such as CCM, CPHQ, BCBA, or in utilization management.

• Preferred: advanced proficiency in PC applications and familiarity with CPT/HCPCS and ICD-10 coding.

• Preferred: knowledge of managed care, utilization management, and quality management principles.

🏝️ Benefits

• Remote work arrangement with no regular onsite requirements.

• Full-time schedule of at least 40 hours per week.

• Opportunities for continuing education.

• Training and professional development through onboarding, education, coaching, and staff development initiatives.