RN Trainer/Quality - Commerical Inpatient Precert

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.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" 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="http://www.bcbsm.com/index/about-us/our-company.html" 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="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: support,leadership,prepare,performance,compliance,administration,training,knowledge,management,experience,degree,nurse,professional


Competitive Compensation and Benefits Package

Overview: <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>
Responsibilities: <ul> <li> <div><span style="font-size: small;">Responsible for educating staff in managed care as it relates to department programs, processes and systems.</span></div> </li> <li> <div><span style="font-size: small;">Conduct quality reviews on all precertification and Wellness, Care Management and Health Promotion cases.</span></div> </li> <li> <div><span style="font-size: small;">D</span><span style="font-size: small;">evelops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual criteria updates as needed.</span></div> </li> <li> <div><span style="font-size: small;">Oversee and mentor new employees during the initial training program.</span></div> </li> <li> <div><span style="font-size: small;">Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training.</span></div> </li> <li> <div><span style="font-size: small;">E</span><span style="font-size: small;">ducate 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.</span></div> </li> <li> <div><span style="font-size: small;">Prepare all training materials and develop training packages with related materials assigned by leadership.</span></div> </li> <li> <div><span style="font-size: small;">Participate in development, testing and implementation of new programs and systems as assigned.</span></div> </li> <li> <div><span style="font-size: small;">Share performance information with operations and training management in an effort to determine next steps.</span></div> </li> <li> <div><span style="font-size: small;">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.</span></div> </li> <li> <div><span style="font-size: small;">Other duties as assigned.</span></div> </li> <li> <div><span style="font-size: small;">Travel may be required.</span></div> </li> </ul>
Requirements: <ul> <li><span style="font-size: small;">Nursing Diploma or Associates Degree in Nursing required</span></li> <li><span style="font-size: small;">Bachelor in Nursing (BSN) or related fields preferred</span></li> <li><span style="font-size: small;">Five (5) years experience in health related fields required</span></li> <li><span style="font-size: small;">Three (3) to five (5) years internal experience with Care Management</span></li> <li><span style="font-size: small;">Effective analytical, verbal, and written communication skills</span></li> <li><span style="font-size: small;">Effective project management skills to create and execute work plans</span></li> <li><span style="font-size: small;">Ability to work independently and in a team environment</span></li> <li><span style="font-size: small;">Ability to manage multiple tasks</span></li> <li><span style="font-size: small;">Proficient in relevant PC applications (Share point, Care Advance, NASCO, 3270, MCMS/AMP, CCDB, IKA and Portico system)</span></li> <li><span style="font-size: small;">Basic knowledge of ICD9/ICD 10 and CPT Codes</span></li> <li><span style="font-size: small;">MEDCO, Member Health Record, VDA (Virtual Desk Top), Care Advance&nbsp;<br /></span></li> <li><span style="font-size: small;">Knowledge of local, state and federal regulations (PA250, PA350, DOL, ERISA, HIPPA</span></li> <li><span style="font-size: small;">Leadership experience</span></li> <li><span style="font-size: small;">In depth understanding of BCBSM benefits and their application</span></li> <li><span style="font-size: small;">Ability to use clinical assessments and interventions</span></li> <li><span style="font-size: small;">Knowledge of effective communication techniques and theories</span></li> <li><span style="font-size: small;">Knowledge of utilization management and InterQual criteria</span></li> <li><span style="font-size: small;">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.</span></li> </ul> <div><span style="font-size: small;"><strong>CERTIFICATES, LICENSES, REGISTRATIONS</strong></span></div> <ul> <li><span style="font-size: small;">Registered Nurse with current unrestricted Michigan Registered Nurse license required.</span></li> <li><span style="font-size: small;">CM certification preferred</span></li> </ul>