RN Medical Management Trainer – Managed Care
Medical Management Trainer Job Summary:
Develop and educate clinical staff on the company's clinical philosophy and evidence based practice methods required for excellent patient outcomes and regulatory requirements for care management and utilization management.
Identify training needs outside of core curriculum to promote maximized effectiveness in managing medical costs and improving clinical outcomes.
Maintain and monitor the delivery and effectiveness of the training programs, identify solutions to challenges and implement improvements.
Assist with the development and evaluation of performance goals and objectives and quality management activities.
Develop and facilitate new hire orientation for the clinical staff and ensure transition of training into daily work activities related to clinical practice, patient safety and evidence-based practice.
Performs quality audits and facilitates inter-rater reliability assessments to ensure standardization and consistency with clinical decisions.
Support and provide education with process improvement programs and technical applications.
Develop programs to support educational needs as determined by management.
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
Medical Management Trainer Background:
Valid, unrestricted state Registered Nurse (R.N.) license
Bachelor’s Degree in Nursing (BSN) or related field is a plus.
Certified in Utilization Management (CPUM/CPUR/CPHM) or Case Management (CCM/ACM) is preferred
Roughly 5 years’ clinical nursing experience in a high acuity setting.
Around 3 years’ experience in Utilization Review/ Utilization Management for a Managed Care Organization (Health Plan, IPA, HMO, TPA, etc), including previous supervisory experience.
Prefer 4-5 years of combined experience in quality auditing, training, and utilization management .
Strong computer proficiency (MS Office) and presentation skills are necessary.
Skilled in influencing, leading and directing individuals in multiple functional areas.
Able to transform assignments from high-level objectives into independently established detailed goals.
Excellent verbal and written communication skills, as well as exceptional critical thinking skills.