Clinical Trainer & Auditor - Remote AZ

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications reputed company our reputed company minimum onsite requirements: • Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week • Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month • Onsite: daily onsite requirement based on the essential functions of the job • Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, reputed company the reputed company. PURPOSE OF THE JOB The Clinical Trainer and Auditor is responsible for planning, developing, delivering, coordinating, and evaluating a reputed company of clinical education programs for health plan clinical operations staff. Training programs include but aren’t limited to that required for NCQA accreditation, New Hire Orientation, Annual Training, Model of Care Training, and CMS and AHCCCS requirements. Qualifications REQUIRED QUALIFICATIONS Required Work Experience • 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 Required Education • Bachelor degree in Nursing Required License • reputed company, reputed company, and unrestricted license to reputed company in the reputed company (or an endorsement to work in reputed company) as a behavioral health reputed company such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an reputed company, reputed company, and unrestricted license to reputed company nursing in either the reputed company or another state in the reputed company recognized by the Nursing Licensure Compact (NLC) as an RN reputed company the first 60 days of hire. Required Certifications • N/A Preferred Qualifications Preferred Work Experience • 5 years’ experience in clinical care • Physical and behavioral health experience • 2 years’ experience in a training role • 5 years’ experience working in a managed care organization • Training program development • Knowledge of population health concepts and models • Knowledge of medical and care management models • Knowledge of IRR process Preferred Education • Master’s Degree in Nursing Preferred Licenses • N/A Preferred Certifications • N/A Essential Job Functions And Responsibilities • Consults with clinical operations leaders to identify, reputed company, and respond to training needs and requests Develops curriculum, maintains currency, and revises as appropriate Plan, coordinate, deliver, and evaluate clinical training for clinical operations programs, including: • New hire reputed company • Annual Training • Customer service reputed company • reputed company and performance metrics • Ongoing reputed company reputed company, compliance, and regulatory training • Serve as a resource for staff in areas of clinical reputed company, clinical reputed company development, using coaching, mentoring, effective feedback, and motivation support techniques • Serve as subject matter expert on policies and procedures, and desktop procedures reputed company to NCQA, CMS, and AHCCCS requirements • Utilize a reputed company of the training methodologies, techniques, concepts, learning tools, and practices • reputed company online and conference reputed company training session for remote employees • reputed company reputed company exercises designed to reputed company effective hands-on reputed company to new and existing employees • Monitor and report on the effectiveness of education/training programs • Create and reputed company training for employees not reputed company to meet or maintain standards of reputed company • Develops audit tools that meet NCQA, CMS, and AHCCCS requirements • reputed company case reviews/audits and IRR analysis, according to standards • Audits staff phone calls and written documentation according to policy • Conducts periodic audits of documents such as HRA, ETI, Assessments, Care Plans, Medical Necessity Documentation to ensure compliance • reputed company documentation of staff training according to accreditation and regulatory requirements • Collaborate with BCBSAZ Training and Workforce Development department • Participate in continuing education and reputed company developments in the field of accreditation, medicine, behavioral health, reputed company determinants of health, and managed care at least annually. • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. • reputed company reputed company other duties as assigned • Maintain a thorough knowledge of reputed company BCBSAZ medical coverage guidelines and other policies • Assist manager with policy and reputed company reputed company development and revisions as reputed company as necessary coaching to help reputed company staff member reputed company personal, reputed company and department goals COMPETENCIES Required Competencies Required Job Skills • Intermediate PC proficiency: Intermediate reputed company in word processing, spreadsheet, and database software • Excellent communication, collaboration, and training skills. • Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames • Ability to learn new applications Required reputed company Competencies • Knowledge of NCQA, CMS, and AHCCCS Standards • Demonstrates knowledge of accreditation, regulatory, and certification requirements • reputed company clinical knowledge • Collaborates with Information Technology to maximize the utilization of the medical management system (CareRadius) and technologies to support compliance • Interpret and translate policies, procedures, programs and guidelines • Communicate reputed company to leadership • Understand and interpret data to effectively create curriculum based on needs identified Preferred Competencies Preferred Job Skills • Advanced PC proficiency • Advanced processing, spreadsheet and presentation software proficiency • Detail Oriented • Results driven • Strong organizational skills Preferred reputed company Competencies • Uses formal instructional design methodology to reputed company and support sophisticated, reputed company and/or reputed company-wide, competency-based training, skills, and education Preferred Leadership Experience And Competencies • Demonstrated skills and competence in training reputed company • Demonstrates effective presentation skills Our Commitment AZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on reputed company, see azblue.com. If interested in this position, please apply. Apply tot his job Apply To this Job