Highmark-posted 3 months ago
$57,700 - $107,800/Yr
Full-time • Mid Level
Remote • Remote Position, PA
5,001-10,000 employees
Insurance Carriers and Related Activities

This job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and/or proprietary business systems, updates or creates course materials to reflect changes in processes or systems and manages the department training effectively to ensure efficient and effective learning. Ensures that educational programs meets with all compliance, regulatory and contractual requirements. Conducts ongoing audit review programs, develops tools to assess current outcomes and trends along with Directors, Managers and Supervisors. Develops educational interventions to maintain contractually mandated standards of care as it applies to existing and future Policies, Workflows, and Systems functions. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review. Develops ongoing educational programs that ensures clinical and non-clinical staff are evaluated at designated intervals to maintain proficiency level that meets Contractual and Regulatory Requirements as well as individual productivity measures. The incumbent requires a knowledge base that integrates clinical and technical systems training to ensure that business functions/processes are in compliance with NCQA Regulations and ongoing contractual directives. Delivers highly complex training courses and workshops in support of workforce development, technology and/or proprietary business systems, updates and/or creates course materials to reflect changes in processes or systems and manages and leads the classroom effectively to ensure learning.

  • Responsible for the Coordination of all duties associated with the new hire onboarding process, programs, materials and execution.
  • Conduct ongoing assessment and training for current staff based on an ongoing assessment of the program with any revisions that maybe needed associated with Business, Regulatory, Accrediting Body or Contractual identified needs.
  • Identify audit trends/issues with associated program development, to ensure adherence to all departmental policies and procedures.
  • Coordinate with relevant team members to evaluate impact of ongoing Policy development as it impacts the need for associated workflows and staff education.
  • Act as a SME in association with Operating Platform Development as it impacts clinical and non-clinical workflows/training/documentation.
  • Participation in system testing and regression testing to identify any gaps in function as it applies to the staff ability to meet all mandated Business/Regulatory or Contractual obligations.
  • Other duties as assigned.
  • High School diploma/GED
  • 3 - 5 years in Case Management
  • Registered Nurse or Licensed Clinical Social Worker (LCSW) - Non-Specific
  • Bachelor's degree in Nursing
  • Bachelor's degree in Social Work
  • 5 - 7 years in Nursing
  • 5 - 7 years in Social Work
  • ACM Certification (Accredited Case Manager)
  • 401k
  • health insurance
  • dental insurance
  • vision insurance
  • life insurance
  • disability insurance
  • paid holidays
  • paid volunteer time
  • tuition reimbursement
  • professional development
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