Clinical Trainer & Auditor - Remote AZ

Blue Cross Blue Shield of Arizona; Arizona; Hybrid; USD 70,000 - 95,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a Clinical Trainer and Auditor to design, deliver, and evaluate clinical education for clinical operations staff. Training includes NCQA accreditation, CMS and AHCCCS requirements, New Hire Orientation, and ongoing compliance.

The role requires full-time work with hybrid/onsite/remote options; collaboration with IT and Training teams to optimize CareRadius and related tools. AZ licensure and 2+ years in managed care are preferred.

Qualifications

• ~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.
• Active nursing license to practice in AZ or equivalent licensure.

Responsibilities

• Plan, develop, deliver, coordinate and evaluate clinical education for clinical operations programs.
• Develop onboarding, annual training, CMS/AHCCCS compliance education and competency tools.
• Provide online and live training sessions for remote employees and onsite staff.
• Monitor effectiveness of training and report outcomes against quality metrics.
• Collaborate with IT and Training & Workforce Development to maximize systems use.
• Audit staff performance and maintain documentation for accreditation standards.

Skills

Managed care experience

NCQA CMS AHCCCS knowledge

Auditing experience

Training delivery

Curriculum development

Education

Bachelor degree in Nursing

AZ nursing license or equivalent behavioral health license

Job description

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. Our positions are classified as hybrid, onsite or remote.

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

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

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.

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.

Required Work Experience

• ~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

Bachelor degree in Nursing

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.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.

Preferred Work Experience

• ~2 years’ experience in a training role
• ~Training program development
• ~ Knowledge of medical and care management models
• ~ 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
• 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.

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

Intermediate skill in word processing, spreadsheet, and database software

Excellent communication, collaboration, and training skills.

Ability to learn new applications

Knowledge of NCQA, CMS, and AHCCCS Standards

Demonstrates knowledge of accreditation, regulatory, and certification requirements

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

Understand and interpret data to effectively create curriculum based on needs identified

Advanced processing, spreadsheet and presentation software proficiency

Uses 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

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.