Clinical Auditor/Trainer

Company: MJHS
Location: New York
Posted on: November 14, 2024

Job Description:

Job DescriptionJob DescriptionThe challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.The Clinical Trainer/Auditor, under the direction of the UM Director, is responsible for training UM clinical staff, by being the primary support for the orientation, job-related training and continuing education. The trainer/auditor is responsible for all aspects of training, including content development using principles of adult learning, updating training materials based on company policies and procedures, regulatory changes, published best practice, clinical guidelines and overall workflow improvement strategies. The trainer/auditor is also responsible for conducting of both standard regulatory audits and monitoring of day-to-day processes for the UM team. The trainer/auditor is responsible for assessing overall compliance with policies/processes, as well as trending individual staff performance and reporting findings to the Medical Management team. This position is also responsible for oversight of any coordinator staff assigned to assist in documentation gathering, running reports, meeting management, etc.

• Bachelor's in nursing, required, Master's preferred
• Licensed RN, NY State
• 5 years of utilization management experience in a managed care or healthcare setting required
• 2 years' instructional design and program development experience and familiarity with adult learning concepts preferred
• Prior experience delivering classroom and virtual instructor led training preferred
• Prior motivational interviewing training experience preferred
• Experience using Interqual Guidelines required
• Knowledge of the principals surrounding utilization management/organizational determination required

Keywords: MJHS, Lower Merion , Clinical Auditor/Trainer, Accounting, Auditing , New York, Pennsylvania