About the role
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 LicenseActive, 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
N/A
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 LicensesN/A
Preferred CertificationsN/A
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.
Originally posted on Himalayas