RN Clinical Trainer / Auditor - Denver Health Medical Plan (Must Be a Colorado Resident)

We are recruiting for a motivated RN Clinical Trainer / Auditor - Denver Health Medical Plan (Must Be a Colorado Resident) to join our team!

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Department

Managed Care Administration

Must Be a Colorado Resident

Job Summary

This position is responsible for developing, delivering, monitoring and maintaining a variety of clinical training programs for the Health Services Department. The position is further responsible for creating comprehensive auditing tools to ensure standardization and consistency of nurse reviewer clinical decisions, compliance to department policies and procedures, and compliance to regulatory standards. Team member is responsible for collaborating with health plan leadership to identify training needs outside of core curriculum to promote maximized effectiveness in managing behavioral and medical costs. The Trainer / Auditor will maintain and monitor the delivery and effectiveness of the training program and identify solutions to challenges. This includes maintaining records of training activities and employees' progress. Will work with audit team to identify and develop training based on the results of audits and corrective actions. Will work with business partners and IT to develop, implement, monitor, and evaluate workplace performance and training solutions. Responsible for coordinating training from external vendors to meet the needs of the department. This position develops, implements and manages learning interventions in support of employee learning and performance related projects. In addition, may need to be a resource to assist / advise Supervisors and / or process authorizations as needed.

Essential Functions

Develop and administer a universal training curriculum for new Health Services employees, as well as ongoing training to maintain identified core competencies (10%)

Develop training curriculum based on clinical staff knowledge, needs, and areas of improvement needed as identified by senior leadership, staff request, or other business indicators (10%)

Designs and develops appropriate and effective instructional materials and content for Medical Management systems (Examples : QNXT, Guiding Care MCG, JIRA, etc.) (10%)

Coordinate training efforts with various cross-functional areas within clinical department (Referral Coordinators, Inpatient and Outpatient Clinical Teams, etc.) (10%)

Participate in cross functional teams (HPS, Claims, IT, Product, Compliance, etc.) to identify and solve system issues (5%)

Develop teaching aids such as training handbooks, demonstration models, multimedia visual aids, computer tutorials, and reference works as applicable (10%)

Serves as an advocate for learning and change management in project planning meetings and effectively communicate project plans, milestones and training strategy on an ongoing basis. Example : System Upgrades (5%)

Evaluate effectiveness of training programs, including cost and benefit analyses and communicate results to management (10%)

Audit team results, identify gaps in training and implement improvements in training programs (5%)

Prepare audit findings, documentation of deficiencies as well as develop final analysis reports for Health Services Department Leadership (5%)

Responsible for staying abreast of product / member / provider issues, legislation, CMS mandates, policy changes and system changes so they can be considered for training topics (5%)

Collaborates with Health Services leadership to implement and monitor individual CAPs and / or PIPs as necessary. (5%)

Assist and advise supervisors as needed. (5%)

Process authorization requests as needed. (5%)

Education

Bachelor's Degree in Nursing (BSN) required

Work Experience

1-3 years comprehensive knowledge of Utilization Management in a managed care environment required and

1-3 years experience working with Milliman Care Guidelines (MCG), InterQual and / or other clinical criteria / guidelines required and

Less than 1 year experience training in a virtual environment desirable

Less than 1 year clinical training / education and instructional design experience, preferably in managed care, preferred

Licenses

RN-Registered Nurse - DORA - Department of Regulatory Agencies required

Knowledge, Skills And Abilities

Strong written and verbal communications.

Excellent organizational skills and strong attention to detail

High level of personal accountability and integrity

Ability to gather, analyze data and prepare informative and accurate reports.

Ability to understand the workflow of multiple components of the company and to assist in the creation and implementation of integrated policies, procedures, workplans and creative solutions.

Advanced PC proficiency

Good working knowledge of regulatory requirements / standards.

Ability to work with others or independently with minimal supervision

Shift

Days (United States of America)

Work Type

Regular

Salary

$92,900.00 - $143,900.00 / yr

Benefits

Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

Free RTD EcoPass (public transportation)

On-site employee fitness center and wellness classes

Childcare discount programs & exclusive perks on large brands, travel, and more

Tuition reimbursement & assistance

Education & development opportunities including career pathways and coaching

Professional clinical advancement program & shared governance

Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

Respect

Belonging

Accountability

Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.