RN Clinical Trainer, Utilization Management - Denver Health Medical Plan ( Must Reside in Colorado )
About The Position
We are recruiting for a motivated RN Clinical Trainer, Utilization Management - Denver Health Medical Plan ( Must Reside in Colorado ) to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Managed Care Administration Must Reside in Colorado Job Summary This position is responsible for developing, delivering, monitoring, and maintaining a variety of clinical training programs for Utilization Management (UM) department. The position is further responsible for creating comprehensive monitoring tools to ensure standardization and consistency of nurse reviewer clinical decisions, and compliance with department policies and procedures and regulatory standards. This position is responsible for collaborating with UM leadership to identify training needs outside of the core curriculum to promote maximized effectiveness in Interrater Reliability and cost containment. The Clinical Trainer will maintain and monitor the delivery and effectiveness of the training program along with identifying solutions to challenges. Responsibilities include maintenance of training activity records and employees' progress, as well as working with audit team to identify and develop targeted training to address audit results and/or corrective actions. This may include coordinating training from external vendors to meet the needs of the department. Working with business partners and IT, this position will develop, implement, monitor, and evaluate learning interventions, workplace performance and training solutions. In addition, this position will be a resource to assist and advise Supervisors/Team Leads, process authorizations and respond to staff questions.
Requirements
- Associate's Degree Associate of Science in Nursing required
- 1-3 years comprehensive knowledge of Utilization Management in a managed care environment required
- 1-3 years experience working with Milliman Care Guidelines (MCG), InterQual and/or other clinical criteria/guidelines required
- Less than 1 year clinical training/education and instructional design experience required , preferably in managed care
- RN-Registered Nurse - DORA - Department of Regulatory Agencies required
- Strong written and verbal communications.
- Excellent organizational skills and strong attention to detail
- High level of personal accountability and integrity
- Ability to gather, analyze data and prepare informative and accurate reports.
- Ability to understand the workflow of multiple components of the company and to assist in the creation and implementation of integrated policies, procedures, workplans and creative solutions.
- Advanced PC proficiency
- Good working knowledge of regulatory requirements/standards.
- Ability to work with others or independently with minimal supervision
Nice To Haves
- Less than 1 year experience training in a virtual environment desirable
Responsibilities
- Develop and administer a universal training curriculum for new Utilization Management employees, as well as ongoing training to maintain identified core competencies
- Develop training curriculum based on clinical staff knowledge, needs, and areas of improvement needed as identified by senior leadership, staff request, or other business indicators
- Designs and develops appropriate and effective instructional materials and content for Medical Management systems (Examples: QNXT, Guiding Care MCG, JIRA, etc.)
- Develop and maintain teaching aids such as training handbooks, demonstration models, multimedia visual aids, computer tutorials, and reference works as applicable
- Responsible for staying abreast of product/member/provider issues, legislation, CMS mandates, policy changes and system changes so they can be considered for training topics
- Participate in cross functional teams (HPS, Claims, IT, Product, Compliance, Grievance and Appeals etc.) to identify and solve system issues
- Serves as an advocate for learning and change management in project planning meetings and effectively communicate project plans, milestones and training strategy on an ongoing basis. Example: System Upgrades
- Collaborates with leadership to implement and monitor individual CAPs and/or PIPs as necessary
- Monitor team results, identify gaps in training and implement improvements in training programs
- Prepare audit findings, documentation of deficiencies as well as develop final analysis reports for Department Leadership
- Evaluate effectiveness of training programs, including cost and benefit analyses and communicate results to management
Benefits
- Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
- Free RTD EcoPass (public transportation)
- On-site employee fitness center and wellness classes
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education & development opportunities including career pathways and coaching
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
1,001-5,000 employees
