Utilization Management Assistant Jobs in Oregon (NOW HIRING)

Clinical Systems Trainer RN

---------------------------------------------------------------

The Clinical Systems Trainer is responsible for training staff in the correct and effective use of decision tools used for utilization management activities and assess staff readiness to begin their specific role in the Division at the conclusion of training. As new initiatives and functionalities arise, they work jointly with Clinical Operations leadership to identify training opportunities and implement strategies to ensure ongoing training needs are met. They are responsible for onboarding and orientation of new clinical employees to clinical guideline tools (InterQual); they author guidelines from regulatory requirements or customize from nationally recognized clinical content or organizational criteria to meet CareOregon's needs. They lead the ongoing training of clinical staff as new guidelines are developed. They develop training and reference materials to ensure staff have the tools needed to streamline operational workflows and overall meet regulatory compliance. They support audit activities as requested.
NOTE: This position is work from home, but you must reside in Oregon or SW WA. The schedule is either M-F or 4 ten-hour days Tuesday - Friday.

Estimated Hiring Range:

$113,940.00 - $139,260.00

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

---------------------------------------------------------------

Essential Responsibilities

Conduct onboarding training sessions for newly hired clinical staff in utilization management workflows.

Develop and maintain job aids to support core workflows.

Facilitate remediation training for identified deviation by individuals and/or teams from policies, procedures, and processes.

Lead ongoing training refresher sessions for clinical staff.

Build evaluation of staff training and provides feedback to respective managers.

Responsible for departmental reporting of aggregate training activities.

Track all activities which can be used as support documentation for CMS or OHA audits.

Identifies training opportunities and implements strategies to ensure ongoing training needs are met.

Assist in internal and external audits as requested.

Implements strategies to ensure staff comply with internal or external plan of corrections.

Develop, review, and update clinical content, ensuring accuracy and relevance.

Ensure all content complies with current clinical standards and regulations.

Maintain up-to-date knowledge of clinical practices and Medicare and Medicaid guidelines.

Assist in the development of training materials and educational resources.

Participate in quality improvement initiatives and projects.

Design, develop, and update clinical content through the review and understanding of information gathered from regulatory and organizational requirements.

Collect and incorporate feedback from internal customers to ensure clinical accuracy and usability.

Perform Quality Assurance testing of clinical content and create and maintain clinical documentation.

Serve as a clinical resource for both internal customers, including training of new content both created and as part of the product.

Collaborate with Medical Directors and Clinical Operations leadership team for organizational criteria.

Participate in developing project plans, monitoring tasks and ensuring on-time delivery of clinical content.

Experience and/or Education

Required

• Registered Nurse (RN) license
• Minimum 2 years of clinical experience working with clinical guidelines

Preferred

• Experience in clinical content creation or medical writing
• Experience with InterQual
• Experience with training and onboarding
• Experience applying Oregon Medicaid and Medicare coverage guidelines

Knowledge, Skills and Abilities Required

Knowledge

• Proficiency with nationally accepted clinical guidelines, such as InterQual or MCG
• High degree of competence in continual improvement, project management, change management, and program development
• Knowledge of clinical workflows
• Knowledge of learning collaborative and practice facilitation strategies
• Strong computer literacy
• Basic understanding of software development phases

Skills and Abilities

• Ability to work with minimum supervision
• Ability to develop, test, and evaluate programmatic initiatives
• Strong abilities in building relationships with multiple entities
• Excellent written and verbal communication skills
• Ability to work independently and as part of a team
• Strong attention to detail and organizational skills
• Ability to manage multiple projects and meet deadlines
• Strong people management skills, including the ability to coach and motivate teams
• Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
• Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
• Ability to influence and build consensus
• Ability to work in an environment with matrix reporting
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.