Utilization Management Clinician Trainer

PacificSource Health Plans

22h

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Provide and/or coordinate all initial new hire training. Identify training department needs and arrange for continued education for all Behavioral Health (BH) and Physical Health (PH) Clinical staff. Develop and maintain desktop reference (DTR) and resource materials. Facilitate and coordinate training of clinical mentor, and subject matter expert roles within Health Services. Active participation in policy and desk top reference development. Essential Responsibilities: Develop, maintain, and present training programs in coordination with Health Services Leadership Team which ensure Clinicians are trained to provide exceptional clinical expertise and quality outcomes. Develop, organize, and maintain a centralized electronic system of reference tools and training materials, including desktop references and resources. Standardize and maintain training materials to reflect current practice & compliance standards both internally as well as within the broader health insurance industry. Ensure regulatory compliance with all state and federal guidelines as well as other accrediting entities. When applicable identify and negotiate with appropriate vendors to provide services and negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development. Understand appropriate Care Management and Health Management referrals. Work with Health Services Team Leaders in all aspects of training. Identify ongoing training needs for all Clinicians. Develop/maintain appropriate training materials. Assist with quarterly audit processes. Utilize additional evidence-based methodology to ensure staff are able to demonstrate competencies. Ensure that each new hire is provided with the tools to successfully begin their new position. Meet with the new employee quarterly for the first year to determine additional educational needs. Attend Policy and Procedure meetings and participate in initiating, reviewing and editing of policies when relevant. Attend NTOC and other interdepartmental meetings as indicated. Utilize lean methodologies for continuous improvement. Expertise in identifying, working with, and developing individualized approaches to different adult learning styles and in creating customized trainings/educational modalities for different audiences. Practice and model effective communication skills: both written and verbal. Maintain working knowledge and understanding of the essential responsibilities of UM Clinician functions as outlined in a UM Clinician Job Description. Supporting Responsibilities: Act as backup for other Health Services Department staff and functions as needed. Serve on designated committees, teams, and task groups, as directed. Represent the Heath Services Department, both internally and externally, as requested by Medical Director or other member of the senior leadership team. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

Requirements

Minimum of four (4) years of nursing or clinical behavioral health experience with varied health care exposure and experience required.
Registered nurse with current unrestricted state licenses(s) or Licensed Clinical psychologist, LCSW, or comparable behavioral health professional with extensive experience and/or credentials (e.g. Licensed Professional Counselor, PC, Licensed Marriage and Family Therapist LMFT, Psychiatric Mental Health Nurse Practitioner, PMHNP) with current unrestricted state license(s).
Thorough knowledge and understanding of medical (for PH Trainer) and behavioral health processes (for BH Trainer), diagnoses, care modalities, procedure codes including health insurance and state-mandated benefits.
Understanding of contractual benefits and options available outside contractual benefits.
Working knowledge of community services, providers, vendors and facilities available to assist members.
Ability to use computerized systems for data recording and retrieval.
Assures patient confidentiality, privacy, and health records security.
Establishes and maintains relationships with community services and providers.
Thorough knowledge and understanding of adult learning styles.
Maintains current clinical knowledge base and certification.
Ability to work independently with minimal supervision.
Must be able to function as part of a collaborative, cohesive community.
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Accountability
Collaboration
Communication (written/verbal)
Flexibility
Listening (active)
Organizational skills/Planning and Organization
Problem Solving
Teamwork
Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Nice To Haves

Six (6) months of experience within PacificSource Health Services Department preferred.
Experience in teaching or coaching preferred.
Case Manager Certification as accredited by CCMC preferred.

Responsibilities

Provide and/or coordinate all initial new hire training.
Identify training department needs and arrange for continued education for all Behavioral Health (BH) and Physical Health (PH) Clinical staff.
Develop and maintain desktop reference (DTR) and resource materials.
Facilitate and coordinate training of clinical mentor, and subject matter expert roles within Health Services.
Active participation in policy and desk top reference development.
Develop, maintain, and present training programs in coordination with Health Services Leadership Team which ensure Clinicians are trained to provide exceptional clinical expertise and quality outcomes.
Develop, organize, and maintain a centralized electronic system of reference tools and training materials, including desktop references and resources.
Standardize and maintain training materials to reflect current practice & compliance standards both internally as well as within the broader health insurance industry.
Ensure regulatory compliance with all state and federal guidelines as well as other accrediting entities.
When applicable identify and negotiate with appropriate vendors to provide services and negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development.
Understand appropriate Care Management and Health Management referrals.
Work with Health Services Team Leaders in all aspects of training.
Identify ongoing training needs for all Clinicians.
Develop/maintain appropriate training materials.
Assist with quarterly audit processes.
Utilize additional evidence-based methodology to ensure staff are able to demonstrate competencies.
Ensure that each new hire is provided with the tools to successfully begin their new position.
Meet with the new employee quarterly for the first year to determine additional educational needs.
Attend Policy and Procedure meetings and participate in initiating, reviewing and editing of policies when relevant.
Attend NTOC and other interdepartmental meetings as indicated.
Utilize lean methodologies for continuous improvement.
Expertise in identifying, working with, and developing individualized approaches to different adult learning styles and in creating customized trainings/educational modalities for different audiences.
Practice and model effective communication skills: both written and verbal.
Maintain working knowledge and understanding of the essential responsibilities of UM Clinician functions as outlined in a UM Clinician Job Description.
Act as backup for other Health Services Department staff and functions as needed.
Serve on designated committees, teams, and task groups, as directed.
Represent the Heath Services Department, both internally and externally, as requested by Medical Director or other member of the senior leadership team.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.