Um Supervisor Of Clinical Audit & Training (Rn)

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

• Dependent Tuition Reimbursement for clinical staff!
• Affordable medical, dental and vision coverage for employee and family members
• FREE Online RN to BSN and MSN degree programs!
• And MORE!
• Tuition Reimbursement for all full and part-time staff
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• Generous paid time off
• Sign-on Bonuses OR Student Loan Assistance for clinical staff

Responsibilities:

The Utilization Management (UM) Supervisor of Clinical Audit & Training position, under the direction of the UM Director, is responsible for training UM clinical staff, by being the primary resource for the orientation, job-related training, and continuing education. The Supervisor is responsible for all aspects of training, including content development using principles of adult learning, updating training materials based on company policies and procedures, regulatory changes, published best practice, clinical guidelines, and overall workflow improvement strategies. The Supervisor is also responsible for conducting both standard regulatory audits and monitoring day to day processes for the UM team. As part of the Medical Management team and content expert, the Supervisor is responsible for assessing overall compliance with policies/processes as well as trending individual staff performance, and reporting findings to the rest of the Medical Management team. The Supervisor is also responsible for oversight of any coordinator staff assigned to assist in documentation gathering, report pulls, meeting management, etc.

Qualifications:

• Knowledge of the principals surrounding Utilization.
• Experience using InterQual Guidelines required.
• 2 years’ instructional design and program development experience and familiarity with adult learning concepts preferred.
• Prior motivational interviewing training experience.
• Knowledge of current standards of medical practice and healthcare delivery systems.
• 5 years of utilization management experience in a managed care or healthcare setting required.
• Working knowledge of Windows, Word, and Excel.
• Management/Organizational determination required.
• Baccalaureate Degree in Nursing; Master’s degree preferred
• Prior experience delivering classroom and virtual instructor led training.