Trainer/Quality RN-Care Management Quality Program

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: education,leadership,performance,quality assurance,compliance,administration,training,department notes,degree,experience,skills,knowledge,license and certification


Competitive Total Compensation Package

Overview: <strong><span style="font-size: small;">Responsibilities include providing clinical and educational support assessments, analysis and coordination of the quality management program and assisting in the divisional accreditation process.</span></strong>
Responsibilities: <ul> <li>Responsible for educating staff in managed care as it relates to department programs, processes and systems.</li> <li>Conduct quality reviews on all precertification and Wellness, Care Management and Health Promotion cases.</li> <li>Develops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual criteria updates as needed.</li> <li>Oversee and mentor new employees during the initial training program.</li> <li>Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training.</li> <li>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.</li> <li>Prepare all training materials and develop training packages with related materials assigned by leadership.</li> <li>Participate in development, testing and implementation of new programs and systems as assigned.</li> <li>Share performance information with operations and training management in an effort to determine next steps.</li> <li>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.</li> <li>Other duties as assigned.</li> <li>Travel may be required.</li> </ul>
Requirements: <ul> <li>Nursing Diploma or Associates Degree in Nursing required.</li> <li>Bachelor in Nursing (BSN) or related fields preferred.</li> <li>Five (5) years&rsquo; experience in health-related fields required.</li> <li>Three (3) to five (5) years internal experience with Care Management.</li> <li>Effective analytical, verbal, and written communication skills.</li> <li>Effective project management skills to create and execute work plans.</li> <li>Ability to work independently and in a team environment.</li> <li>Ability to manage multiple tasks.</li> <li>Proficient in relevant PC applications (Share point, Care Advance, NASCO, 3270, MCMS/AMP, CCDB, IKA and Portico system).</li> <li>Basic knowledge of ICD9/ICD 10 and CPT Codes.</li> <li>MEDCO, Member Health Record, VDA (Virtual Desk Top), Care Advance.</li> <li>Knowledge of local, state and federal regulations (PA250, PA350, DOL, ERISA, HIPPA).</li> <li>Leadership experience.</li> <li>In depth understanding of BCBSM benefits and their application.</li> <li>Ability to use clinical assessments and interventions.</li> <li>Knowledge of effective communication techniques and theories.</li> <li>Knowledge of utilization management and InterQual criteria.</li> <li>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.</li> </ul> <p><strong>CERTIFICATES, LICENSES, REGISTRATIONS</strong></p> <ul> <li>Registered Nurse with current unrestricted Michigan Registered Nurse license required.</li> <li>CM certification preferred.</li> </ul> <p><strong><u>Departmental Specifics:</u></strong></p> <p>This position supports the Care Management quality program with NCQA accreditation activities including reviewing cases, writing reports, preparing gap analysis of updated standards, making recommendations to align Care Management initiatives with NCQA requirements, supporting the Care Management Quality Committee and other special projects as needed. Candidates should be proficient with Excel, PowerPoint, Word and Outlook; and able to quickly grasp and articulate complex concepts and subject matter.</p>