JOB DETAILS
LOCATION
Dublin, OH
POSTED
8 days ago

Description

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

As part of the clinical systems training team, the Clinical Systems Trainer plans, develops and conducts education and training programs for staff necessary to meet the organization’s business objectives, regulatory guidelines and improve skills and professional growth and development.

  • Assists with training on utilization of Medical Management software platform and applications utilized by Utilization Management and Case Management staff as requested.  Maintains a current knowledge base with regard to rules, regulations, policies and procedures relating to the implementation of all Medical Management functions: Intake, Prior Authorization, Concurrent Review, Discharge Planning, Alternate Services, DME, Appeals and Case Management. Coordinates clinical and process orientation for all new hires.
  • Arranges and coordinates guest speakers offering educational programs with the provision of CEUs for professional staff.

Education/Experience:

  • Bachelor’s Degree.
  • Master’s Degree preferred.
  • Registered Nurse preferred.
  • Demonstrated ability to identify trends and conduct root-cause analyses.
  • Ability to provide constructive feedback with a focus on improved quality.
  • Ability to communicate in a positive/professional manner both orally and written.
  • Ability to follow detailed instructions with a high degree of accuracy.
  • Ability to work independently; complete tasks in the allotted time frame.
  • Strong problem solving skills and decision making skills.
  • Certified InterQual Trainer preferred.
  • 1-3 years of specific clinical knowledge / experience in Utilization Management and/or Case Management.
  • Active and unrestricted RN License preferred.
  • InterQual/Cerme Experience preferred.
  • Training experience preferred.
  • Experience using EXP, SIR, Jiva, Facets, IQ, CL, RightFax, provider portal, and Ancillary preferred.
  • Experience using Microsoft Office
  • Strong knowledge of clinical criteria – InterQual preferred.
  • Demonstrated knowledge of plan benefit information and managed care preferred.
  • System administration experience preferred.
  • Good interpersonal and personal management skills preferred.
  • Good oral and written communication skills preferred.
  • Ability to work with changing priorities and deadlines preferred.
  • Develop and maintain training tools preferred.
  • Manage and update training library preferred.
  • Understanding of  Compliance and Confidentiality information.
  • Liaison to business auditing preferred.