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Clinical Trainer, Auditor
Blue Cross Blue Shield of ArizonaClinical Trainer & Auditor responsible for training health plan clinical operations staff at AZ Blue. Planning and delivering various clinical education programs while ensuring compliance with accreditation standards.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in developing and delivering clinical training programs, ensuring compliance with NCQA, CMS, and AHCCCS standards. Proficient in utilizing various training methodologies and conducting audits to maintain high standards of clinical practice.
Highest-signal resume keywords
Clinical Training DevelopmentNCQA ComplianceManaged Care ExperienceAudit ExperienceBehavioral Health Licensure
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Curriculum DevelopmentTraining EvaluationClinical CareRegulatory TrainingAudit Tools DevelopmentCase ReviewsPerformance MetricsCompliance DocumentationTraining MethodologiesEffective Feedback Techniques
Soft Skills
CoachingMentoringMotivational SupportCollaborationEffective Communication
Certifications & Qualifications
Active Nursing LicenseBehavioral Health Professional License
Industry Keywords
NCQACMSAHCCCSManaged CareClinical OperationsContinuing EducationSocial Determinants of HealthAccreditationQuality AssurancePerformance Improvement
About the role
Key responsibilities & impact- Consults with clinical operations leaders to identify, develop, and respond to training needs and requests
- Develops curriculum, maintains currency, and revises as appropriate
- Plan, coordinate, deliver, and evaluate clinical training for clinical operations programs, including: New hire onboarding, Annual Training, Customer service excellence, Quality and performance metrics, Ongoing professional growth, compliance, and regulatory training
- Serve as a resource for staff in areas of clinical practice, clinical professional development, using coaching, mentoring, effective feedback, and motivation support techniques
- Serve as subject matter expert on policies and procedures, and desktop procedures related to NCQA, CMS, and AHCCCS requirements
- Utilize a variety of the training methodologies, techniques, concepts, learning tools, and practices
- Provide online and conference call training session for remote employees
- Develop valid exercises designed to provide effective hands-on practice to new and existing employees
- Monitor and report on the effectiveness of education/training programs
- Create and develop training for employees not able to meet or maintain standards of excellence
- Develops audit tools that meet NCQA, CMS, and AHCCCS requirements
- Perform case reviews/audits and IRR analysis, according to standards
- Audits staff phone calls and written documentation according to policy
- Conducts periodic audits of documents such as HRA, ETI, Assessments, Care Plans, Medical Necessity Documentation to ensure compliance
- Provide documentation of staff training according to accreditation and regulatory requirements
- Collaborate with BCBSAZ Training and Workforce Development department
- Participate in continuing education and current developments in the field of accreditation, medicine, behavioral health, social determinants of health, and managed care at least annually.
Requirements
What you’ll need- 3 years’ experience in clinical care
- 2 years of work experience in a managed care setting
- Prior experience in NCQA Surveys, CMS Program Audit, and/or AHCCCS Operational Review
- Prior audit experience
- Bachelor degree in Nursing
- Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN within the first 60 days of hire.
Benefits
Comp & perks- Flexible work arrangements
- Professional development