We are recruiting for a motivated RN Clinical Trainer/Auditor - Denver Health Medical Plan (Must Be a Colorado Resident) to join our team!
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Department
Managed Care Administration*Must Be a Colorado Resident*
Job Summary
This position is responsible for developing, delivering, monitoring, and maintaining a variety of clinical training programs for the Health Services Department. It also involves creating comprehensive auditing tools to ensure standardization and consistency of nurse reviewer clinical decisions, compliance with department policies and procedures, and adherence to regulatory standards. The team member will collaborate with health plan leadership to identify training needs beyond the core curriculum to maximize effectiveness in managing behavioral and medical costs. The Trainer/Auditor will oversee the delivery and effectiveness of training programs, identify challenges, and implement solutions. Responsibilities include maintaining records of training activities and employee progress, working with the audit team to develop training based on audit results and corrective actions, and coordinating with business partners and IT to develop, implement, monitor, and evaluate workplace performance and training solutions. The role also involves coordinating external vendor training and developing, implementing, and managing learning interventions to support employee development. Additionally, the position may provide guidance to supervisors and assist with process authorizations as needed.
Essential Functions:
1. Develop and administer a universal training curriculum for new Health Services employees and ongoing training to maintain core competencies (10%)
2. Create training curriculum based on clinical staff knowledge, needs, and areas for improvement as identified by leadership, staff requests, or other indicators (10%)
3. Design and develop instructional materials and content for Medical Management systems (e.g., QNXT, Guiding Care MCG, JIRA) (10%)
4. Coordinate training efforts with various clinical department areas (Referral Coordinators, Inpatient and Outpatient Clinical Teams, etc.) (10%)
5. Participate in cross-functional teams to identify and resolve system issues (5%)
6. Develop teaching aids such as handbooks, demonstration models, multimedia aids, tutorials, and reference materials (10%)
7. Advocate for learning and change management, communicate project plans, milestones, and training strategies (5%)
8. Evaluate training program effectiveness, including cost-benefit analyses, and report findings to management (10%)
9. Analyze audit results, identify training gaps, and implement improvements (5%)
10. Prepare audit findings and deficiency documentation, and develop final analysis reports for leadership (5%)
11. Stay informed about product/member/provider issues, legislation, CMS mandates, policies, and system changes relevant to training (5%)
12. Collaborate with leadership to implement and monitor CAPs/PIPs as necessary (5%)
13. Assist and advise supervisors as needed (5%)
14. Process authorization requests as needed (5%)
Education:
* Bachelor's Degree in Nursing (BSN) required
Work Experience:
* 1-3 years of comprehensive knowledge of Utilization Management in a managed care environment (required)
* 1-3 years of experience working with Milliman Care Guidelines (MCG), InterQual, and/or other clinical criteria (required)
* Less than 1 year experience in virtual training desirable
* Less than 1 year clinical training/education and instructional design experience, preferably in managed care (preferred)
Licenses:
* RN-Registered Nurse - DORA required
Knowledge, Skills, and Abilities:
* Strong written and verbal communication skills
* Excellent organizational skills and attention to detail
* High personal accountability and integrity
* Ability to analyze data and prepare accurate reports
* Understanding of company workflows and ability to create and implement policies and solutions
* Advanced PC proficiency
* Knowledge of regulatory requirements and standards
* Ability to work independently or with others
Shift
Days (United States of America)
Work Type
Regular
Salary
$92,900.00 - $143,900.00 / yr
Benefits
* Comprehensive benefits including up to 27 paid days off, retirement contributions, medical plans
* RTD EcoPass (public transportation)
* On-site fitness center and wellness classes
* Childcare discounts and perks on brands, travel, etc.
* Tuition reimbursement and assistance
* Career development and coaching
* Clinical advancement programs and shared governance
* Public Service Loan Forgiveness (PSLF) eligibility and student loan support
* Eligible for NHCS and CHSC programs
Our Values
* Respect
* Belonging
* Accountability
* Transparency
Note: All safety-sensitive positions require passing a pre-employment drug test after a conditional offer. Denver Health is an integrated health system and a primary safety-net provider in Colorado, committed to community service and excellence. We are an equal opportunity employer and value diversity. Applications will be considered until the position is filled.
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