Libsysinc

Company Details

Senior Trainer/Auditor- Utilization Management

Job ID

: 21674

Location

: Tacoma, WA, USA

Salary

: $80000 per year

Job Views

: 134

Posted

: 03-07-2019

Job Description

Job description
Position Purpose: Develop, conduct, administer and analyze clinical training programs, conduct audits of clinical systems entry and/or processes, and assist in development of audit tools for Utilization Management team. 
 
  • Develop and conduct clinical education courses, including case management education and training for new employees
  • Develop and maintain complex audit processes and audit tools related to authorizations, appeals, quality, case management, inter-rater reliability and data entry
  • Audit established guidelines (e.g. Interqual) for medical necessity
  • Analyze training needs and identify, select or develop appropriate training programs including training aids and materials
  • Audit staff in accordance with established auditing processes, work with staff to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management
  • Train audit staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
  • Evaluate effectiveness of training programs including cost/benefit analyses
  • Research, analyze, and recommend internal/external training programs
  • Maintain records of training activities and employee progress
  • Assist with revisions to Policy and Procedure and/or work process development
  • Participate in Quality and Advisory committees) or provider education meetings
  • Travel may be required
Qualifications:
Education/Experience: Bachelor’s degree in Nursing, related clinical field or equivalent experience. 4+ years of experience in nursing, training, or auditing in a managed care healthcare setting. Experience in a lead or supervisory role preferred. 

License/Certification: Current state nursing license, RN or LPN. Driver’s license may be required for certain positions.
 
Must have experience in Utilization Management including concurrent review and prior authorizations. 
 
Experience with Interqual highly preferred. 
 
What are the 3-4 non-negotiable requirements on this position?
- Experience training and/or curriculum design - UM experience- concurrent review, prior auth - Managed care experience with provider or MCO - Proficient with Microsoft Office - Must have RN or LPN (RN highly preferred)
 
What are the nice-to-have skills?
- Experience with Interqual - Strong organization skills - Strong verbal and written communication
Job Category
Finance Health-Care
Employment Types
Full time
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