Clinical Training – Quality Specialist

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

📋 Description

• Evaluate individual Operations team members' clinical decisions in relation to clinical guidelines.

• Convert QA findings into actionable insights and recommendations for operational leaders and cross-functional collaborators.

• Design and implement structured coaching sessions based on audit results.

• Develop and ensure the precision of SOPs, job aids, workflow guides, and materials for new product readiness.

• Conduct onboarding and continuous upskilling sessions for Clinical teams, applying adult learning principles and feedback from subject matter experts.

• Oversee the QA and Training components of project implementations by operationalizing workflow modifications, quality standards, and training updates.

• Collaborate with Product, Clinical, Client Services, and Operations to validate workflow adjustments and identify quality or compliance risks.

• Facilitate change management by communicating process updates and aligning QA expectations across affected teams.

• Act as a subject matter expert and consultant to frontline leaders regarding quality trends, training requirements, and operational preparedness.

• Manage several concurrent priorities independently while remaining accountable for deliverables.

• Step in to operational queues as necessary during peak periods to uphold service levels and ensure continuity.

• Mentor team members to enhance performance against quality metrics.

• Supply performance and quality-improvement reports to senior leadership.

• Perform additional duties as assigned.

⛳️ Requirements

• Current RN Licensure.

• A minimum of 2 years of experience in the Coverage Determinations process in Healthcare.

• Familiarity with NCQA and CMS standards for Utilization Management Authorization decisions.

• Knowledge of LCD/NCD Coverage Determination.

• Capability to conduct impactful coaching sessions.

• Understanding of Adult Learning Theory and Training methodologies.

• Strong attention to detail.

• Excellent verbal and written communication abilities.

• Skills in data collection, management, and analysis.

• Proficient in problem analysis and resolution.

• Strong planning and organizational skills.

• Effective interaction with stakeholders.

• Proficiency in Google Workspace (Sheets, Docs, Forms).

• Experience in building pivot tables and creating charts or dashboards is a plus.

• Background in identifying performance trends and root causes through data analysis is an advantage.

• Experience with quality management systems and performing structured QA audits is a plus.

• Background in facilitating coaching sessions and providing constructive feedback is a plus.

🏝️ Benefits

• Fully remote position with approximately 5% travel required.

• Comprehensive medical, dental, vision, life, and disability insurance, along with an Employee Assistance Program.

• 401K retirement plan with company match.

• Flexible spending and health savings accounts.

• Flexible Time Off policy.

• Company Holidays.

• Up to 14 weeks of paid parental leave.

• Pet insurance.

• Bonus included in the total benefits package.