Clin Ops Educ & Excell Coord (UM focus) (Trainers)

Job Summary:

The Clinical Operations Education & Excellence Coordinator creates and delivers state of the art training to Clinical Operation’s employees and monitors the quality and competency of performance through auditing for achieving or exceeding business excellence at CareSource.

Essential Functions:

• Participate in the implementation of the department’s training and audit strategy to support the achievement of Care Sources mission and business performance goals and national learning strategy.
• Create, implement and evaluate utilization management and case management training programs and audit tools to support the development of CareSource employees, skills and competencies to help achieve business excellence.
• Utilize a variety of educational media to ensure the right training is available to support the specific needs of multiple diverse audiences within areas of accountability.
• Deliver training that successfully transfers learning from the classroom to the expected job functions and responsibilities of the learner.  
• Participate in the installation of new business relevant to area of responsibility and expertise. 
• Provide oversight, direction, and support for new staff orientation in conjunction with CSU and UM/CM preceptors
• Contributes /participates in process improvement meetings and initiatives.
• Contribute to the development and implementation of quality improvement plan for utilization and care management providing recommendations based on clinical audit findings
• Develop and train utilization or care management specific education, mentoring and coaching to promote quality and consistency across the clinical ops functions
• Provide 1:1 coaching to CM/UM staff to promote consistency across clinical ops roles.
• Review and analyze both automated and manual authorizations requests and decisions for trends.
• Execute quality monitoring reviews of provider requests
• Execute quality monitoring reviews as defined by the Clinical Op’s Quality Monitoring Policy and Procedures (SOP’s) and e-Manuals 
• Assist in identifying and evaluating any risk areas and provide input to the development of process improvements
• Perform quality monitoring procedures, education to staff to define issues
• Pursue development opportunities, including external and internal training, and share information gained with co-workers
• Perform any other job duties as requested

Education and Experience:

• Completion of an accredited nursing degree program or Bachelor of Science/Arts Degree in Social Work, Health and Human Services or related field, or equivalent years of relevant work experience is required
• A minimum of three (3) years of clinical experience is required
• Training/teaching experience with demonstrated knowledge of adult learning and instructional design is required
• Utilization Management or Case Management experience is preferred
• Medicaid/Medicare or Commercial experience is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office Suite to include Word, Excel and PowerPoint Advanced proficiency with clinical documentation systems
• Ability to translate staff needs into a variety of learning and performance improvement strategies
• Excellent written and verbal communications skills
• Ability to create, evaluate and present department, role-focused materials across topics with excellent public speaking skills
• Ability to develop, prioritize and accomplish goals
• Listening and critical thinking skills
• Strong problem solving skills with attention to detail
• Strong interpersonal skills and high level of professionalism
• Knowledgeable in the prospective, retrospective and concurrent review process of inpatient admissions, outpatient procedures, homecare services and durable medical equipment
• Basic level of proficiency with data entry and internet skills
• Ability to work independently and within a team environment
• Familiarity of the healthcare field
• Proper grammar usage
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Strong organizational skills
• Change resiliency

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Professional Behavioral Health Clinical counselor (LPCC), or other similar professional healthcare related licensure or certification is required
• Case Management certification is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Perform reasonable travel, which could include overnight travel, to fulfill the responsibilities of the position
• Flexible hours, including possible evenings

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.