Responsible for overall analysis, design, development and implementation, and evaluation of Health Plan (Insurance) Services educational activities. Develop and instruct associates about CMCHP policies and procedures, State and Federal requirements that include access to covered services, access to Texas Health Steps, physical/behavioral health services, community-based services, regulatory assessments, home modifications and other requirements from the State.
- Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field
- Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands, and the factors that differentiate the organization in the market
- Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements
- Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
- Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies
- Works independently, receives minimal guidance
- Explains difficult or sensitive information; works to build consensus
Job Specific Responsibilities:
- Assist in evaluating the clinical and non-clinical staff skill level and competency in the delivery of clinical and regulatory programs
- Use ADDIE (Analysis, Design, Development, Implementation, and Evaluation) and Agile consulting best practices to deliver training solutions for the Health Plan.
- Develop standardized materials for training purposes
- Train new and current staff on clinical and non-clinical competencies and systems
- Conduct departmental in-services
- Maintain compliance with clinical and non-clinical training programs in conjunction with program requirements and State and Federal regulations
- Conduct Quality Improvement Audits
- Up train staff when deficiencies are identified
- Indirect - Indicates that the person in the position is responsible for a product (including information) or service that is involved in the patient’s course of care, treatment or service.
- 5+ years direct patient contact in an acute setting required
- 3+ years of managed care experience required
- 1+ year healthcare training or quality management experience required
- Proficiency with MS Office preferred
- Proficiency with Adobe Creative Suite preferred
- Proficiency with eLearning authoring tools like Captivate and Articulate Storyline preferred
Specific Knowledge, Skills and Abilities:
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
- Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
- Four-year Bachelor's degree or equivalent experience required
- Graduate or professional work or advanced degree; or equivalent experience preferred
Licenses and Certifications:
- Current, unrestricted license to practice nursing in the State of Texas preferred
- Certified Clinical Coder, Certified Case Manager, Certified Case Manager, UM Certification, Certified Medical Audit Specialist preferred
- Light - Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.