Clinical Training & Compliance Auditor (NCQA/CMS)

Jobtailor; Phoenix (AZ); On-site; USD 70,000 - 90,000; Full time

Job summary

Jobtailor seeks an experienced clinical training professional to design and deliver comprehensive training programs for clinical operations. You will develop curricula, coordinate onboarding and annual trainings, and evaluate program effectiveness to ensure alignment with NCQA, CMS, and AHCCCS standards.

You will serve as a subject matter expert in regulatory requirements and provide coaching, feedback, and mentorship to staff, including remote employees, with a keen focus on quality improvement

Qualifications

• 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

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.

Skills

Curriculum Development

Training Evaluation

Clinical Care

Regulatory Training

Audit Tools Development

Case Reviews

Performance Metrics

Compliance Documentation

Training Methodologies

Effective Feedback Techniques

Education

Bachelor degree in Nursing

Active Nursing License

Behavioral Health Professional License

Job description

Jobtailor seeks an experienced clinical training professional to design and deliver comprehensive training programs for clinical operations. You will develop curricula, coordinate onboarding and annual trainings, and evaluate program effectiveness to ensure alignment with NCQA, CMS, and AHCCCS standards.

You will serve as a subject matter expert in regulatory requirements and provide coaching, feedback, and mentorship to staff, including remote employees, with a keen focus on quality improvement