RN Utilization Management Trainer – Managed Care
Phoenix, AZ
Utilization 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.
- 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.
Utilization 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) of 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.
#CLINICAL
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