Blue Cross Blue Shield of Michigan RN Trainer/Quality - Commerical Inpatient Precert in Detroit, Michigan
Responsibilities include providing clinical and educational support assessments, analysis and coordination of the quality management program and assisting in the divisional accreditation process.
Responsible for educating staff in managed care as it relates to department programs, processes and systems.
Conduct quality reviews on all precertification and Wellness, Care Management and Health Promotion cases.
Develops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual criteria updates as needed.
Oversee and mentor new employees during the initial training program.
Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training.
Educate staff and external provider facilities in the clinical policies criteria and procedures of InterQual as well as an overview of the department, general functions, responsibilities and department relationships with other departments.
Prepare all training materials and develop training packages with related materials assigned by leadership.
Participate in development, testing and implementation of new programs and systems as assigned.
Share performance information with operations and training management in an effort to determine next steps.
Coordinate administrative activities with the training supervisor and operations management, including class evaluations, updating files, class registration, scheduling classes, new hire system/software access, personnel information, and attendance management.
Other duties as assigned.
Travel may be required.
- Nursing Diploma or Associates Degree in Nursing required
- Bachelor in Nursing (BSN) or related fields preferred
- Five (5) years experience in health related fields required
- Three (3) to five (5) years internal experience with Care Management
- Effective analytical, verbal, and written communication skills
- Effective project management skills to create and execute work plans
- Ability to work independently and in a team environment
- Ability to manage multiple tasks
- Proficient in relevant PC applications (Share point, Care Advance, NASCO, 3270, MCMS/AMP, CCDB, IKA and Portico system)
- Basic knowledge of ICD9/ICD 10 and CPT Codes
- MEDCO, Member Health Record, VDA (Virtual Desk Top), Care Advance
- Knowledge of local, state and federal regulations (PA250, PA350, DOL, ERISA, HIPPA
- Leadership experience
- In depth understanding of BCBSM benefits and their application
- Ability to use clinical assessments and interventions
- Knowledge of effective communication techniques and theories
- Knowledge of utilization management and InterQual criteria
- Must be willing to act as a change agent on behalf of Care Management and positively support the inception of new programs, systems, processes, software, and tools.
CERTIFICATES, LICENSES, REGISTRATIONS
- Registered Nurse with current unrestricted Michigan Registered Nurse license required.
- CM certification preferred
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
Job: Health Care Management
Primary Location: Detroit
Organization: Utilization Management-2152
Req ID: COM0001D