RN Medical Management Educator / Trainer – Behavioral Health
Boston, MA (Charlestown)
Medical Management Trainer Job Summary:
The Educator/Trainer will train staff on federal, state, and organizational standards related to the managed care model of providing the full spectrum of health care support used in the medical management of members and patients.
They assist with Behavioral Health (BH) workflow development and training of BH Utilization Management and Care Management processes.
Deliver training to BH team (Clinical Social Workers, Licensed Mental Health Clinicians, Psych, RNs, as well as non clinical support staff such as Specialists, Coordinators, Etc.
They oversee and implement the successful training of newly hired staff for Medical Management procedures, including providing retraining and continuing education for current staff.
The training will be presented to both clinical and non-clinical staff as well as train on company protocols and procedures to perform in their individual functions.
Responsible for needs analysis, strategic planning. and hands-on training for newly hired staff Case Managers, Utilization Review & Prior Authorizations nurses, Quality Improvement specialists, Appeals & Grievance Nurses, as well as other medical management positions.
Responsible for the assessment of educational needs, the design and coordination of programs, the implementation and evaluation of educational services for the ongoing education and competency requirements of clinical and non-clinical staff.
Responsible for creating, developing and maintaining training manuals and tools, as needed.
Review health education materials for content and cultural appropriateness.
Regularly communicates complex information and interacts via electronic documentation and tools.
Acts as a Subject Matter Expert for the organization, providing ongoing retaining and continuing education as well as ad-hoc training to existing staff.
Assists management staff with creation and maintenance of policies and procedures.
This position monitors quality assurance of the utilization reviews and cases to ensure compliance with departmental processes, service level agreements, and regulatory or state standards.
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) preferred
Roughly 5 years’ clinical experience, including Behavioral Health.
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 5 + years of combined experience in quality auditing, training, and utilization management .
Familiar with Commercial, Medicare, and Medicaid plans, as well as claims payment rules and their impact on care management processes.
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.