Blue Cross Blue Shield of Arizona

Health insurance products and services

Clinical Trainer & Auditor - Utilization Management

Corporate & Technical TrainingConfirmed live in the last 24 hours

Full-timeArizona, USANo salary listed

About the Job

Requirements

At least 3 years of experience in clinical care.
At least 2 years of work experience in a managed care setting.
Prior experience with National Committee for Quality Assurance surveys, Centers for Medicare & Medicaid Services program audits, and/or Arizona Health Care Cost Containment System operational reviews.
Prior audit experience.
A Bachelor degree in Nursing.
An active, current, and unrestricted Arizona license (or endorsement to work in Arizona) as a behavioral health professional such as a licensed clinical social worker, licensed professional counselor, licensed substance abuse counselor, marriage and family therapist, or licensed psychologist (Psy.D. or Ph.D.); alternatively, an active, current, and unrestricted registered nurse license in Arizona or another state recognized by the Nursing Licensure Compact, obtained within the first 60 days of hire.
Intermediate proficiency with word processing, spreadsheet, and database software.
Ability to manage multiple tasks and prioritize work to meet deadlines and identified time frames.
Ability to learn new applications.
Knowledge of National Committee for Quality Assurance, Centers for Medicare & Medicaid Services, and Arizona Health Care Cost Containment System standards.
Knowledge of accreditation, regulatory, and certification requirements.
Current clinical knowledge.
Ability to collaborate with Information Technology to maximize use of the CareRadius medical management system and technologies supporting compliance.
Ability to interpret and translate policies, procedures, programs, and guidelines.
Ability to communicate outcomes to leadership.
Ability to understand and interpret data to create curriculum based on identified needs.
Ability to work a full-time schedule of at least 40 hours per week, plus additional hours as requested or needed.

Responsibilities

Consult with clinical operations leaders to identify, develop, and respond to training needs and requests.
Develop curriculum, maintain its currency, and revise it as appropriate.
Plan, coordinate, deliver, and evaluate clinical training for clinical operations programs, including new-hire onboarding, annual training, customer service excellence, quality and performance metrics, ongoing professional growth, compliance, and regulatory training.
Serve as a resource for staff in clinical practice and professional development, using coaching, mentoring, effective feedback, and motivation support techniques.
Serve as a subject matter expert on policies, procedures, and desktop procedures related to National Committee for Quality Assurance, Centers for Medicare & Medicaid Services, and Arizona Health Care Cost Containment System requirements.
Use a variety of training methodologies, techniques, concepts, learning tools, and practices.
Provide online and conference-call training sessions for remote employees.
Develop exercises that provide effective hands-on practice to new and existing employees.
Monitor and report on the effectiveness of education and training programs.
Create and develop training for employees who are unable to meet or maintain standards of excellence.
Develop audit tools that meet National Committee for Quality Assurance, Centers for Medicare & Medicaid Services, and Arizona Health Care Cost Containment System requirements.
Perform case reviews, audits, and inter-rater reliability analysis according to standards.
Audit staff phone calls and written documentation according to policy.
Conduct periodic audits of health risk assessments, early transition interventions, assessments, care plans, and medical necessity documentation to ensure compliance.
Provide documentation of staff training according to accreditation and regulatory requirements.
Collaborate with the Blue Cross Blue Shield of Arizona Training and Workforce Development department.
Participate at least annually in continuing education and keep current with developments in accreditation, medicine, behavioral health, social determinants of health, and managed care.
Perform other duties as assigned.
Maintain thorough knowledge of Blue Cross Blue Shield of Arizona medical coverage guidelines and other policies.
Assist the manager with policy and practice guideline development and revisions, and provide coaching to help staff reach personal, professional, and department goals.

Desired Qualifications

At least 5 years of experience in clinical care.
Experience in physical and behavioral health.
At least 2 years of experience in a training role.
At least 5 years of experience working in a managed care organization.
Experience with training program development.
Knowledge of population health concepts and models.
Knowledge of medical and care management models.
Knowledge of the inter-rater reliability process.
A Master’s Degree in Nursing.
Advanced PC proficiency.
Advanced proficiency in processing, spreadsheet, and presentation software.
Ability to use formal instructional design methodology to develop and support sophisticated, complex, and/or enterprise-wide competency-based training, skills, and education.
Demonstrated skills and competence in training methods.
Effective presentation skills.

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within 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 reside in AZ, unless otherwise cited within 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 presence 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 future, 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, within the State of Arizona.

PURPOSE OF THE JOB

The Clinical Trainer and Auditor is responsible for planning, developing, delivering, coordinating, and evaluating a variety 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

Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN within the first 60 days of hire.

Required Certifications

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

Preferred Certifications

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Consults with clinical operations leaders to identify, develop, 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 onboarding
Annual Training
Customer service excellence
Quality and performance metrics
Ongoing professional growth, compliance, and regulatory training
Serve as a resource for staff in areas of clinical practice, clinical professional development, using coaching, mentoring, effective feedback, and motivation support techniques
Serve as subject matter expert on policies and procedures, and desktop procedures related to NCQA, CMS, and AHCCCS requirements
Utilize a variety of the training methodologies, techniques, concepts, learning tools, and practices
Provide online and conference call training session for remote employees
Develop valid exercises designed to provide effective hands-on practice to new and existing employees
Monitor and report on the effectiveness of education/training programs
Create and develop training for employees not able to meet or maintain standards of excellence
Develops audit tools that meet NCQA, CMS, and AHCCCS requirements
Perform 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
Provide documentation of staff training according to accreditation and regulatory requirements
Collaborate with BCBSAZ Training and Workforce Development department
Participate in continuing education and current developments in the field of accreditation, medicine, behavioral health, social 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.
Perform all other duties as assigned
Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies
Assist manager with policy and practice guideline development and revisions as well as necessary coaching to help each staff member reach personal, professional and department goals

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

Intermediate PC proficiency: Intermediate skill 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 Professional Competencies

Knowledge of NCQA, CMS, and AHCCCS Standards
Demonstrates knowledge of accreditation, regulatory, and certification requirements
- Current 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 outcomes 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 Professional Competencies

Uses formal instructional design methodology to develop and support sophisticated, complex and/or enterprise-wide, competency-based training, skills, and education

Preferred Leadership Experience and Competencies

Demonstrated skills and competence in training methods
Demonstrates effective presentation skills

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

About the Company

Blue Cross Blue Shield of Arizona

Health insurance products and services

Blue Cross Blue Shield of Arizona provides health insurance products and services to more than 1 million Arizonans, offering plans for individuals, families, and businesses as well as Medicare supplement plans for seniors. It operates as an independent not-for-profit licensee of the Blue Cross Blue Shield Association with a network-based model: members receive care by choosing providers within a negotiated network, while the insurer handles underwriting, benefits administration, claims processing, and care services. The company differentiates itself through its local Arizona footprint, community involvement, and not-for-profit status, plus a broad local presence across Phoenix and other cities. Its goal is to improve the quality of life for Arizonans by delivering affordable health coverage and tools to help people make better health decisions, supported by community volunteering and charitable contributions.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Phoenix, AZ
Founded: 1939

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