Education Manager, Clinical (Grievance & Appeals)

VNS Health; New York (NY); On-site; USD 98,000 - 131,000; Full time

Benefits offered by this job

Referral bonuses

generously paid PTO 30 days + 9 hols

Health insurance for you & family

Employer-matched retirement plan

Tuition reimbursement

Professional growth opportunities

Job summary

VNS Health is seeking an experienced nursing education specialist to plan, develop, deliver, and evaluate training programs supporting Grievance & Appeals operations. The role focuses on compliance with Medicare, Medicaid, and organizational policies, coordinating with multiple departments to create educational materials and performance support resources.

The candidate will lead clinical staff development, align programs with CMS Triple Aim, and drive improvements in training effectiveness and

Qualifications

• Nurse licensure valid in jurisdiction.
• Bachelor's Degree in Nursing or equivalent work experience required.

Responsibilities

• Designs and delivers clinical education programs to improve care quality and compliance.
• Collaborates to create annual training calendar for organization-wide programs.
• Ensure programs align with CMS Triple Aim principles and patient-centered care.
• Oversee orientation, in-services, and staff development within budget constraints.
• Evaluate program outcomes and implement improvements.

Skills

Grievance & Appeals experience

Communication skills

Analytical skills

Coaching

Education

Bachelor's Degree in Nursing

Tools

Computer applications

Job description

Overview

Plans, develops, delivers, and evaluates training and education programs that support Grievance & Appeals (G&A) operations for VNS Health Health Plans. Designs engaging instructor-led, virtual, and self-paced learning experiences that prepare new and existing staff to perform their roles in compliance with Medicare, Medicaid, regulatory, and organizational requirements. Collaborates with operational, clinical, compliance, quality, and leadership teams to develop and maintain curriculum, educational materials, job aids, and performance support resources that reflect current policies, processes, and best practices. Identifies knowledge gaps, evaluates training effectiveness, and implements targeted learning solutions to improve employee performance, operational excellence, and regulatory compliance. Serves as a subject matter resource on G&A processes and requirements, ensuring consistent delivery of standardized education that supports quality outcomes and continuous improvement. Works under general direction.

Grievance & Appeals experience required.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Manages and delivers program specific clinical education programs designed to foster high quality care through implementation of evidence-based practice, performance improvement activities, and professional staff development.
• Collaborates with Education staff across the enterprise in the development of an annual training calendar to ensure a coordinated approach to ongoing programs.
• Ensures clinical education programs are aligned with CMS Triple Aim framework: improving the patient's experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.
• Ensures clinical education programs address patient centered needs. Identifies and communicates protocols and standards of care for a cultural and demographic diverse patient population; provides education intervention guidelines based on these population health needs.
• Manages implementation of clinical staff development programs such as orientation, in-services, training and other learning activities. Ensures that development and delivery of programs meet the strategic objectives of specific programs.
• Ensures all clinical education programs are in accordance with standards of nursing and social work practice, state and federal regulations and VNS Health policies and procedures.
• Reviews program specific educational program outcomes and program evaluations to determine areas for improvement and makes recommendations for change and/or new programs for clinical education as appropriate. Presents improvement strategies to department leadership.
• Trains and/or oversees training of new and current staff in VNS Health/program philosophy, policy, standards, procedures, documentation, models for service delivery and efficient, productive, cost-effective work processes.
• Monitors and evaluates performance of newly hired staff and staff referred on for remedial or additional training. Counsels, disciplines, terminates or extends probation for staff based on performance during introductory, probationary or training period.
• Designs new and modifies existing educational curriculum and training materials to ensure staff has current knowledge and competencies to meet program contractual and regulatory compliance.
• Conducts educational needs assessment in collaboration with operations staff to identify learning needs among staff. Analyzes and utilizes assessment data to plan for program educational sessions. Develops education programs such as workshops and/or group learning activities; follows up to ensure programs are effectively implemented.
• Identifies performance issues and develops performance improvement plans for tenured employees in collaboration with program management. Evaluates competency and performance in conjunction with program management.
• Reviews and evaluates clinical orientation and ongoing educational program outcomes to determine areas for improvement and recommends changes to current orientation program as appropriate. Participates in the development of revised programs and/or materials.
• Communicates ongoing e-learning opportunities. Evaluates e-learning usage and effectiveness; identifies opportunities for distance learning.
• Analyzes course evaluations in order to evaluate effectiveness of training sessions and to implement improvements.
• Participates in the development of annual clinical education strategic goals and objectives.
• Utilizes resources and practices sound fiscal responsibility; provides input for the development of the department budget. Monitors expenditures and ensures compliance with budgetary constraints.
• Collaborates with Quality department in the development of and implementation of education related training programs.
• Ensures program content is presented in a manner that promotes learning and enables trainees to meet competency requirements.
• Demonstrates services excellence and creates and implements education and training programs which are centered on the goals and strategies of VNS Health.
• Performs other supervisory related duties and projects as assigned.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications:

Licensure: Current license and registration to practice as a Registered Professional Nurse, or Licensed Practical Nurse required

Education: Bachelor's Degree Nursing or equivalent work experience required.

Work Experience: Minimum five years' experience in Grievance and Appeals. Knowledge of health care delivery systems, patient care, care coordination, case management, and clinical processes required. Experience assessing and designing clinical education programs preferred. Experience in a health care setting in a teaching capacity with an understanding of adult education and learning processes preferred. Effective oral and written communication, presentation, analytical, coaching and organizational skills required. Knowledge of computer applications required

Pay Range

USD $98,200.00 - USD $130,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.