Medical Review Training Specialist

ABOUT MACHINIFY:

In October 2025, Machinify acquired Performant and we are now part of the Machinify organization.  Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. 

ABOUT THE OPPORTUNITY:

Hiring Range: $70,550.00 - $82,000

The Medical Review Training Specialist for Clinical Nursing partners with applicable operational business leaders, including functions such as compliance, appeals, and quality, and is responsible for the development, delivery, and continuous improvement of operational training program and tools for the line of business that contributes to increasing staff capability and its overall success.  This position requires strong subject matter expertise, experience developing and delivering training content via a variety of methods and tools effective for remote workforce, excellent interpersonal and communication skills, and demonstrated ability to have meaningful impact on operational workforce capability through training programs and tools.
 

Key Responsibilities to include:

• Employ a variety of methods to maintain current in-depth knowledge, requirements, and subject matter expertise for business segment (legal, regulatory, compliance, and client requirements) in a dynamic environment.

• Develop structured training program and material for policies & procedures and comprehensive review guidelines for audit, operations support, and other audit-related staff, with a specific emphasis on clinical nurse review.

• Maintaining the calendar of assigned training and ensuring that training is scheduled and delivered based upon internally developed timelines, legal, and contractual requirements, as applicable.

• Plan, coordinate, deliver, track, monitor, and report new hire training, as well as ongoing training as required for periodic refreshers, performance improvement, new or modified operating procedures, workflows, tools, requirements, etc.

• Employ a variety of methods to gather information and input to assess training gaps and programs effectiveness such as 360-degree feedback (from trainees, management, and applicable stakeholders), operational performance and QA results, appeals and other metrics at individual and group level, as well as  from audit performance, QA results, Appeal metrics and other inputs.

• Provide instruction and direction to employees on proper usage of on-line training tools, and provides follow-up to ensure staff completion of required assigned training in a timely manner, leveraging support from employee’s management and/or HR if required.

• Apply outcomes of program assessment and needs inputs toward continuous improvement and further development of training program scope, courses, materials, and tools.

• Utilize effective adult learning training pedagogy to maximize successful knowledge transfer and skill building, as well as tools and methods for efficiency in training records management effectively in remote/virtual classroom, as well as in-office training.

• Conduct effective training 1:1 and various group size settings.

• Serve as a subject matter expert regarding official clinical guidelines, audit system functionality and audit workflows and files. Knowledge of payer reimbursement methodologies is a plus.

• Provide training on Audit guidelines, to ensure compliance with client requirements and in conformance with proper clinical nursing practices.

• Deliver concept-based training which may include reviewing operative reports and other documentation to properly code services using current CPT, HCPCS and ICD 10 CM/PCS codes.

• Proactively monitor changes to coding/clinical methodologies, official guidelines, regulatory standards, and update training material for delivery to auditors using relevant training methods.

• Support Medical Review management in documenting workflows and process improvement plans as needed.

• Provide consultative input to the development of business requirements for audit platform and reporting enhancements to prepare for User Acceptance testing and development of relevant training materials; deliver training on new client implementation, new audit programs, new audit products and/or new audit concepts.

• Conduct User Acceptance Testing on new workflow platform and/or reporting enhancements, ensuring correct functionality, documenting all changes and incorporating changes into training materials and training plans as required.

• Leads by example.

• Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements).  Basic office equipment required to perform remote work is provided by the company.

• Other duties as required and assigned by management to meet overall business needs.

Knowledge, Skills and Abilities Needed:

• Strong operational subject matter expertise clinical nursing practices.

• Must have exposure and experience with health care technology (Electronic Medical Records, Coding software and Practice Management Information Systems).

• Knowledge of laws, regulations, or policies impacting the Healthcare industry and understanding of Managed Care requirements under the Medicare/Medicaid and other third-party payor programs.

• Demonstrated ability to take complex ideas and large amounts of information and distill to key learning concepts and principals appropriate for audience intended learning and development.

• Ability to rapidly comprehend and teach new information.

• Demonstrated strength facilitating/presenting information to various audiences in a professional manner with high success in knowledge transfer and skill enhancement.

• Ability to implement concepts of adult learning principles, instructional design, needs assessment and performance measurement and evaluation.

• Demonstrated Project/program management skills.

• Good research and problem-solving skills.

• Demonstrated technical competence to quickly learn and leverage various applications and tools.

• Intermediate to advanced skills in Word, Excel, PowerPoint, and curriculum development tools. Experience developing and delivering learning materials through a Learning Management System (LMS) highly desired.

• Demonstrated ability to develop high quality training plans, courses, and content, with effective delivery and assessment methods.

• Must have ability to work with sensitive information and maintain confidentiality.

• Builds credibility and trust.

• Mind-set of continuous improvement and adapts quickly to change.

• Excellent written and verbal communication, and interpersonal skills.

• Ability to effectively interact with all levels internal and external to the organization.

• Demonstrates ability to apply good judgment.

• Can work independently as well as effectively collaborate within a team and cross-functionally.

• Self-motivated and ability to drive results given direction in the form of objectives.

• Demonstrates good judgement in decision making.

• Possess excellent analytical skills and strong attention to detail.

• Efficient organization and effective time management.

• Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.

• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

Required and Preferred Qualifications:

• Associate degree in relevant field, or equivalent (additional 4 years of directly applicable experience), Bachelor’s degree preferred.

• Active Registered Nursing license

• AHIMA/AAPC Coding Certification preferred.

• Prior experience in similar role or function with responsibility for developing and delivering effective knowledge and skill development programs is required; delivery of remote learning is highly preferred.

WHAT WE OFFER:

Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify’s Human Resources team to discuss further.

Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING