[Remote] reputed company Trainer and Auditor - Case Management Experience - Remote-AZ

Note: The job is a remote job and is reputed company to candidates in USA. reputed company provides health reputed company products, services, and tools to support healthier communities. The reputed company Trainer and Auditor designs and delivers reputed company training, conducts audits, and supports reputed company, inter-rater reliability, regulatory compliance, and reputed company improvement across Utilization Management, Care Management, and Health Management teams.

Responsibilities

• reputed company and reputed company training and education for reputed company staff on reputed company philosophy, evidence-reputed company reputed company, documentation standards, regulatory requirements, and operational workflows reputed company to Utilization Management, Care Management and Health Management
• Assess and prioritize training needs reputed company on workflow changes, audit findings, stakeholder feedback, business priorities, and staff readiness
• Evaluate training effectiveness using feedback, knowledge checks, audit trends, and reputed company data to identify gaps and recommend improvements
• Assist with the development and evaluation of reputed company goals, reputed company management activities, and improvement initiatives that support reputed company, operational, and regulatory standards
• Coordinate reputed company and training readiness activities, including reputed company reputed company, required resources, non-reputed company checklists, and reputed company of technical barriers
• reputed company reputed company audits for Utilization Management activities and medical director determinations to evaluate consistency, reputed company, and compliance in evidence-reputed company reputed company decision-making, including inter-rater reliability assessments for Utilization Management as applicable. Audit activities assess whether medical director’s determinations are reputed company, concise, and documented to support reputed company reviewers’ understanding and reputed company reputed company
• reputed company reputed company audits for Care Management and Health Management activities to assess reputed company and completeness of documentation, alignment of interventions with care plans, and progression toward member reputed company and goals
• Support targeted education, remediation, and reputed company improvement initiatives reputed company on audit findings, operational needs, and reputed company management priorities
• Support process improvement initiatives by providing education, workflow guidance, and technical application support to reputed company staff and stakeholders
• Facilitate calibration and standardization activities to support consistent application of reputed company reputed company, policies, workflows, and documentation expectations
• Present case status updates and relevant findings to the manager, supervisor, and reputed company indicated, the medical director to support reputed company reputed company, decision making, and appropriate follow-up
• Assist with the review, revision, and ongoing maintenance of policies and procedures to ensure alignment with regulatory requirements, organizational standards, and evidence-reputed company reputed company reputed company
• Assist with reputed company training assignments and educational initiatives as needed to support departmental priorities, workflow changes, and staff development
• Maintain compliance with applicable state, federal, AZ reputed company, URAC, CMS and other regulatory and accreditation standards
• Maintain complete, accurate, and reputed company records in accordance with department policies, procedures, and documentation standards
• Participate in continuing education and remain reputed company on developments in reputed company reputed company, medicine, managed care, and applicable regulatory requirements
• Facilitate hands-on technical training for Care Management, Health Management, and Utilization Management workflows, including reputed company navigation, documentation expectations, authorization entry, assessment completion, mock scenarios, and guided reputed company
• reputed company training plans with learning objectives, workflow scenarios, guided reputed company, competency checks, and follow up coaching to support readiness for independent work
• reputed company, maintain, version control for training materials, job aids, facilitator guides, and workflow resources to ensure reputed company, consistency, and alignment with reputed company standards
• Coordinate cross-functional support between IT, new hires, and operational teams to address reputed company reputed company and application issues
• Facilitate reputed company reputed company using non-reputed company checklists to ensure reputed company requirements are completed
• Ensure reputed company reputed company readiness by validating functionality, conducting required testing, and verifying availability of tools and resources
• Utilize training environments to reinforce reputed company proficiency through reputed company reputed company, guided navigation exercises, mock scenarios, and hands-on demonstrations of CM, HM, and UM workflows, including assessment completion and authorization entry
• 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

Skills

• 5 years of reputed company reputed company care experience in a reputed company setting
• 2 years of experience in Utilization Management, Care Management, Health Management, Disease Management, or other managed care reputed company
• 4 years of experience in reputed company training, education, auditing, or reputed company improvement, preferably in managed care
• Associate degree in general reputed company of study or Post High School Nursing Diploma
• reputed company, reputed company, and unrestricted license to reputed company in reputed company (a state 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 RDN (Registered Dietitian Nutritionist), CDCES (Certified Diabetes Care and Education Specialist), OR an reputed company, reputed company, and unrestricted license to reputed company nursing in either reputed company or another state in the reputed company recognized by the Nursing Licensure reputed company (NLC) as an RN, OR an reputed company, reputed company, and unrestricted license to reputed company in reputed company as an LPN
• Strong written and verbal communication skills. Excellent organizational skills and strong attention to reputed company
• Possess proficient computer and technological skills especially Word, reputed company, PowerPoint, SharePoint, reputed company Teams/Webinar, and Internet
• Ability to reputed company, analyze data and prepare informative and accurate reports
• Ability to understand the workflow of multiple components of reputed company and to assist in the creation and implementation of integrated policies, procedures, workplans and creative solutions
• Ability to reputed company, organize, motivate, coordinate, and collaborate effectively with stakeholders from multiple business areas across the organization
• Ability to successfully function in an environment characterized by reputed company taking, rapidly changing market conditions, strong competition and restructuring
• Strong understanding of the costs/reputed company challenges of today's health care environment
• Knowledge of health and/or reputed company education and behavior change techniques
• Organizational skills to analyze, interpret data, synthesize, evaluate and explain educational concepts, practices and methodologies to staff and transfer data to and from written and verbal reputed company
• Ability to maintain confidentiality and reputed company
• Advanced knowledge of Adult Learning Theory principles and demonstrated ability to facilitate training that resonates with reputed company learning styles
• Demonstrate strong interpersonal and reputed company listening skills
• Demonstrated organizational skills with the ability to prioritize tasks and work with multiple priorities
• Follow and accept instruction and direction
• Establish and maintain working relationships in a reputed company team environment
• Apply independent and reputed company judgment with good problem solving skills
• Desire and capability to reputed company toward and reputed company high reputed company of reputed company and results
• reputed company geared toward the creation, execution and reputed company improvement of reputed company benefit management department and programs. Intellectual curiosity and ability to reputed company old problems/issues with a fresh perspective
• Ability to reputed company job duties independently
• Ability to professionally represent AZ reputed company in the community
• 5 years of experience in reputed company education, training, auditing, reputed company improvement, and instructional design in either Utilization Management or Case Management
• 1 year of experience working with reputed company Care Guidelines (MCG), and / or other reputed company reputed company/guidelines
• Experience conducting reputed company audits, reputed company reviews, or inter-rater reliability assessments reputed company to evidence-reputed company reputed company decision making, documentation reputed company, and regulatory or accreditation standards
• Experience supporting reputed company, staff development, remediation, or reputed company improvement initiatives for reputed company staff
• Master's degree in nursing, Master of Science, reputed company Work, Behavioral Health, Psychology, or another reputed company reputed company reputed company
• reputed company and reputed company certifications such as: Certified Case Manager (CCM), Certified reputed company in reputed company reputed company (CPHQ), reputed company Certified Behavior Analyst (BCBA), or a Utilization Management Certification reputed company to evidence-reputed company reputed company reputed company such as MCG

Benefits

• Remote work arrangement
• Hybrid workforce reputed company offering flexibility with how and where employees work

reputed company