Clinical Systems Trainer, Utilization Management, Registered Nurse

Amerihealth Caritas Health Plan Charleston , SC 29402

Posted 2 months ago

Responsibilities:

As part of the clinical systems training team, the Clinical Systems Trainer plans, develops and conducts education and training programs for staff necessary to meet the organization's business objectives, regulatory guidelines and improve skills and professional growth and development.

  • Assists with training on utilization of Medical Management software platform and applications utilized by Utilization Management and Case Management staff as requested. Maintains a current knowledge base with regard to rules, regulations, policies and procedures relating to the implementation of all Medical Management functions: Intake, Prior Authorization, Concurrent Review, Discharge Planning, Alternate Services, DME, Appeals and Case Management. Coordinates clinical and process orientation for all new hires.

  • Arranges and coordinates guest speakers offering educational programs with the provision of CEUs for professional staff.

Education/Experience:

  • Bachelor's Degree.Master's Degree (preferred).

  • Registered Nurse (preferred).

  • Demonstrated ability to identify trends and conduct root-cause analyses.

  • Ability to provide constructive feedback with a focus on improved quality.

  • Ability to communicate in a positive/professional manner both orally and written.

  • Ability to follow detailed instructions with a high degree of accuracy.

  • Ability to work independently; complete tasks in the allotted time frame.

  • Strong problem solving skills and decision making skills.

  • Certified InterQual Trainer (preferred).

  • 1-3 years of specific clinical knowledge / experience in Utilization Management and/or Case Management.

  • InterQual/Cerme Experience (preferred)

  • Training experience (preferred)

  • Experience using EXP, SIR, Jiva, Facets, IQ, CL, RightFax, provider portal, and Ancillary (preferred)

  • Experience using Microsoft Office

  • Demonstrated knowledge of plan benefit information and managed care (preferred)

  • System administration experience (preferred)

  • Good interpersonal and personal management skills (preferred)

  • Good oral and written communication skills (preferred)

  • Ability to work with changing priorities and deadlines (preferred)

  • Develop and maintain training tools (preferred)

  • Manage and update training library (preferred)

  • Understanding of Compliance and Confidentiality information

  • Liaison to business auditing (preferred).

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Clinical Systems Trainer, Utilization Management, Registered Nurse

Amerihealth Caritas Health Plan