Dane Street

Physician Advisory Services Trainer – Auditor

Dane Street

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • **MAJOR DUTIES & RESPONSIBILITIES**
  • - Onboard and train all new QA hires.
  • - New QAs will be ready for integration into the ops team when the following criteria are met
  • - Collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals).
  • - Serve as a resource for team members regarding operational questions, concerns, and problem-solving.
  • - Provide backup support to QA Supervisors as needed (e.g., invoicing, board balance).
  • - Maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback.
  • - Participate in client calls.
  • - Lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans.
  • - Conduct regular MFR (member-friendly rationale) Workshop training sessions.
  • - Develop onboarding agendas in consultation with Ops Leadership.
  • - Identify and schedule training opportunities/meetings.
  • - Coordinate and track annual client regulatory training requirements.
  • - Update and maintain severity and client-change trackers.
  • - Create and maintain training documentation.
  • - Collaborate on remediation plans for employees.
  • - Provide reviewer training when a Medical Director is unavailable; escalate issues to Medical Directors when appropriate.
  • - Partner with managers and supervisors to support 90-day reviews, annual evaluations, and PIPs.
  • Performance Metrics:
  • - Audit Success: Measured by clarification rates, audit results, and daily/monthly TAT.
  • - Remediation Effectiveness: Measurable performance improvement within defined timelines
  • - Training Success: Evaluated through 90-day and annual employee reviews, and check-ins with new hires (daily, weekly, monthly).
  • Other duties & special projects, as assigned and based on business needs.
  • ****

Requirements

  • **Qualifications:**
  • - RN or LPN license required.
  • - Strong background in clinical operations, training, or quality assurance.
  • - Extensive experience in utilization review, with a strong background in health plan practices.
  • - Experience navigating CMS requirements, health plan criteria, and nationally recognized guidelines such as MCG and InterQual.
  • - Proficient in rationale writing and translation to patient-friendly language.
  • - Excellent communication, coaching, and mentoring skills.
  • - Ability to analyze data and identify trends to drive performance improvements.
  • - Skilled in client collaboration and escalation management.
  • - Proficiency with Google Suite, communication platforms, and related applications.
  • **JOB RELATED SKILLS/COMPETENCIES:**
  • Extensive working knowledge of relevant guidelines. Excellent understanding of medical terminology, critical thinking, ability to manage time efficiently and to meet specific deadlines. Present exceptional communication skills with a clear understanding of company business lines. Computer literacy and typing skills are essential.
  • **WORKING CONDITIONS/PHYSICAL DEMANDS:**
  • Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
  • **WORK FROM HOME TECHNICAL REQUIREMENTS:**
  • Supply and support their own internet services.
  • Maintaining an uninterrupted internet connection is a requirement of all work from home position.
  • This job description is subject to change at any time.
Benefits
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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
clinical operationsquality assuranceutilization reviewrationale writingdata analysisperformance improvementmedical terminologytime managementcomputer literacytyping skills
Soft Skills
communicationcoachingmentoringcritical thinkingclient collaborationescalation management
Certifications
RN licenseLPN license