Apply on Employer Site

CareSource · 22 hours ago

Clinical Ops Education & Excellence Coordinator

United States

Full-time

Remote

Mid Level

$63K/yr - $100K/yr

3+ years exp

CareSource is a leading healthcare organization dedicated to improving the health of its members. The Clinical Operations Education & Excellence Coordinator is responsible for creating and delivering training programs for Clinical Operations employees while ensuring quality and competency through performance auditing.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

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 related duties as requested

Qualification

Training/teaching experienceUtilization Management experienceClinical documentation systemsBachelor's DegreeCase Management certificationCustomer service orientedCommunication skillsProblem solving skillsInterpersonal skillsTime management skills

Required

Bachelor's Degree in Social Work, Health and Human Services or related field required

Equivalent years of relevant work experience may be accepted in lieu of required education

Three (3) years of clinical experience required

Training/teaching experience with demonstrated knowledge of adult learning and instructional design required

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

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 required

Preferred

Utilization Management or Case Management experience preferred

Medicaid/Medicare or Commercial experience preferred

Case Management certification or MCG certification is preferred for the role. Certification respective to your role must be obtained within a designated timeline