JOB SUMMARY
This job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and/or proprietary business systems, updates or creates course materials to reflect changes in processes or systems and manages the department training effectively to ensure efficient and effective learning. Ensures that educational programs meets with all compliance, regulatory and contractual requirements. Conducts ongoing audit review programs, develops tools to assess current outcomes and trends along with Directors, Managers and Supervisors. Develops educational interventions to maintain contractually mandated standards of care as it applies to existing and future Policies, Workflows, and Systems functions. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review. Develops ongoing educational programs that ensures clinical and non-clinical staff are evaluated at designated intervals to maintain proficiency level that meets Contractual and Regulatory Requirements as well as individual productivity measures. The incumbent requires a knowledge base that integrates clinical and technical systems training to ensure that business functions/processes are in compliance with NCQA Regulations and ongoing contractual directives. Delivers highly complex training courses and workshops in support of workforce development, technology and/or proprietary business systems, updates and/or creates course materials to reflect changes in processes or systems and manages and leads the classroom effectively to ensure learning.
ESSENTIAL RESPONSIBILITIES
- New Hire Onboarding Monthly and PRN- Responsible for the Coordination of all duties associated with the new hire onboarding process, programs, materials and execution. Will be responsible for Human Resource Orientation, all line of business training, Operating platform training. Following new hires through ongoing audit/education over the initial 3 month hire period. Collaborates closely with Supervisors and Managers of department on staff progress and assists with remediation plans as indicated. Responsible for coordinating new hire training schedules with preceptors and Supervisors. Ongoing assessment of the program, revisions as Business, Regulatory, Accrediting Body or Contractual as needs evolve and/or are identified.
- Conduct ongoing assessment and training for current staff based on an ongoing assessment of the program with any revisions that maybe needed associated with Business, Regulatory, Accrediting Body or Contractual identified needs. Responsible for annual competency programs for all staff to ensure that we maintain best practice levels of care.
- Identify audit trends/issues with associated program development, to ensure adherence to all departmental polices and procedures. Collaborate and communicate with Supervisors/ Managers throughout the year.
- Coordinate with relevant team members to evaluate impact of ongoing Policy development as it impacts the need for associated workflows and staff education.
- Act as a SME in association with Operating Platform Development as it impacts clinical and non clinical workflows/training/documentation. Participation in system testing and regression testing to identify any gaps in function as it applies to the staff ability to meet all mandated Business/Regulatory or Contractual obligations.
- Other duties as assigned.
EDUCATION
Required
- High School diploma/GED
Substitutions
- None
Preferred
- Bachelor's degree in Nursing
- Bachelor's degree in Social Work
EXPERIENCE
Required
- 3 - 5 years in Case Management
Preferred
- 5 - 7 years in Nursing
- 5 - 7 years in Social Work
LICENSES OR CERTIFICATIONS
Required
- Registered Nurse
or
- Licensed Clinical Social Worker (LCSW) - Non-Specific
Preferred
- ACM Certification (Accredited Case Manager)
SKILLS
- Adult Learning: Theory and Practice
- Creativity Skills
- Clinical Systems
- Company Presentations
- Medicaid
- Project Management
- PowerPoint
Languages (other than English)
- None
Travel Required
25% - 50%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Constantly
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Does Not Apply
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$57,700.00Pay Range Maximum:
$107,800.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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Top Skills
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms.
A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best.
Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia.
We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions.
We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
