Clinical Nurse Educator, Consultant

Blue Shield of California • Rancho Cordova, CA

1d

About The Position

Your Role The Enterprise Learning team is responsible for all new hire and existing staff technical and clinical education for multiple departments within Medical Care Solutions and Health Care Quality and Affordability. This includes Utilization Management, Case Management, Population Health Management, Post Service, and Appeals & Grievances. The Utilization Management Clinical Educator position will report to the Senior Stakeholder Manager in Enterprise Learning. In this role you will be supporting the following: Clinical education programs for new and existing staff supporting Utilization Management. Partner with Utilization Management operational departments to develop clinical training modules for Utilization Management clinical reviews for all lines of business. Responsibilities Your Work In this role, you will:

Requirements

• Bachelor’s degree or equivalent experience, required
• Current and unrestricted California RN license, required
• Minimum 7 years of prior relevant clinical experience, required

Nice To Haves

• Experience working in an acute care clinical setting, preferred
• Experience working for a Health Payer in Utilization Management, preferred
• Knowledge of MCG guidelines, medical policies, and Utilization Management clinical criteria, preferred
• Knowledge of regulatory agencies DMHC, NCQA, CMA, and DHCS regulatory agencies, preferred
• Experience educating and training clinicians, preferred
• Experience developing clinical training programs, preferred
• Experience with navigating multiple systems/resources simultaneously

Responsibilities

• Manage and facilitate formal clinical education for new hires and existing clinical staff for Utilization Management
• Conduct Utilization Management clinical education on multiple inpatient and outpatient medical necessity case scenarios
• Clinical education on Utilization Management clinical criteria for all lines of business (Medicare, Medi-Cal, FEP, Commercial, etc.)
• Develop and design training modules for clinical education for Utilization Management using clinical expertise and medical necessity criteria
• Clinical new hire and continuing education on Utilization Management department processes and workflows
• Create learning competencies and assessments for Utilization Management education program
• Support Utilization Management learning projects for Blue Shield of California
• Act as a liaison and provide support and resources to Utilization Management medical directors and clinicians
• Partner will the quality and documentation teams to address quality trends or compliance issues and ensure documentation is precise and easy to follow
• Attend clinical conferences and educational webinars on Utilization Management clinical criteria and education
• Support education on regulatory mandates for Utilization Management
• Use the ADDIE model to support Utilization Management projects
• Use Kirkpatrick model to evaluate Utilization Management learning effectiveness

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level