Responsibilities include providing clinical and educational support assessments, analysis and coordination of the quality management program and assisting in the divisional accreditation process

Responsible for training A&G clinical staff on processes, policies, and systems Participate & lead in the development, implementation, and updating of training manuals to reflect new approaches to training, departmental and/or system process changes and MCG criteria updates as needed Oversee and mentor new employees during the initial training program Work closely with the leadership team, QA, and subject matter experts external and internal to assess the learning environment and determine relevant resources for training Educate staff in the clinical policies criteria and procedures of MCG as well as an overview of the department, general functions, responsibilities and department relationships with other departments Develop and maintain all training materials and develop training packages with related materials assigned by leadership Participate in development, testing and implementation of new programs and systems as assigned Share performance information with operations and training management in an effort to determine next steps Coordinate administrative activities with the leadership team, including class evaluations, updating files, class registration, scheduling classes, new hire system/software access, personnel information, and attendance management • Implement ongoing training for experienced nurses Document outcome of educational processes and share with leadership Travel may be required (less than 10%) depending on business need This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

EMPLOYMENT QUALIFICATIONS: 

Registered Nurse with current unrestricted Registered Nurse license in any of the 50 US states required MCG certification an advantage Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged

EXPERIENCE: 

Five (5) years experience in health related fields required Three (3) to five (5) years experience with appeals grievances, UM, claims, QA, CMS & MCG guidelines

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

Effective analytical, verbal, and written communication skills Effective project management skills to create and execute work plans Ability to work independently and in a team environment  Ability to manage multiple tasks Proficient in relevant PC applications (Share point, Care Advance, NASCO, 3270, MCMS/AMP, CCDB, IKA and Portico system) Basic knowledge of ICD9/ICD 10 and CPT Codes MEDCO, Member Health Record, VDA (Virtual Desk Top), Care Advance Knowledge of local, state and federal regulations (PA250, PA350, DOL, ERISA, HIPPA) Leadership experience  Ability to use clinical assessments and interventions Knowledge of effective communication techniques and theories Knowledge of appeals, grievances, claims, UM, quality and/or MCG criteria Must be willing to act as a “change agent” on behalf of Health Management and positively support the inception of new programs, systems, processes, software, and tools