Trainer/Quality RN

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.

United States, 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.&nbsp;<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 />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 />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: job description,performance,training,develop,quality assurance,educate,administration,mentor,travel,knowledge,experience,education,skills,certification

Non-Manager

Competitive Total Compensation Package

Overview: <p>** Must live in MI and very occasional travel to office may be required.</p> <p>Responsibilities include providing clinical and educational support assessments, analysis, coordination of the quality management program, assisting in the divisional accreditation process, and conducting/assisting with internal and external audits.</p>
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 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 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>Coordinate and perform internal and external audits as required.</li> <li>Travel may be required.</li> </ul>
Requirements: <ul> <li>Nursing Diploma or Associate Degree in Nursing required.</li> <li>Bachelor&rsquo;s degree in nursing (BSN) or related fields preferred.</li> <li>Five (5) years of experience in health-related fields required.</li> <li>Three (3) to five (5) years' internal experience with Care Management, Utilization Management is preferred.</li> <li>Registered Nurse with current unrestricted Michigan Registered Nurse license required.</li> <li>CM certification preferred.</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 (SharePoint, 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 Desktop), Care Advance.</li> <li>Knowledge of local, state, and federal regulations (PA250, PA350, DOL, ERISA, HIPPA, CMS).</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 &ldquo;change agent&rdquo; on behalf of area and positively support the inception of new programs, systems, processes, software, and tools.</li> <li>Current unrestricted State of Michigan clinical license required (RN, MSW, PhD, etc.).</li> </ul> <p>&nbsp;</p> <p><strong>Department Summary / Preferences:</strong></p> <ul> <li>Trainer experience is highly preferred.</li> <li>Proficient in PowerPoint, Excel and Word.</li> </ul>