CHANGE HEALTHCARE Quality Assurance- Nurse Trainer in SALT LAKE CITY, Utah
Transforming the future of healthcare isn't something we take lightly. It takes teams of the best and the brightest, working together to make an impact.As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.If you're ready to embrace your passion and do what you love with a company that's committed to supporting your future, then you belong at Change Healthcare.Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.Empower Your Future. Make a Difference.Quality Assurance- Nurse TrainerOverview of PositionThis position monitors quality assurance of the utilization reviews and case management cases to ensure compliance with departmental processes, service level agreements, and regulatory or state standards. This position works closely with the Health Services Manager and-or Director, Medical Director, and Compliance Department.What will be my duties and responsibilities in this job?* Conducts real-time quality review of utilization reviews prior to referral for secondary review and performs quality assurance review of notices of action or certification* Conducts quality review of case management cases to ensure compliance* Conducts quality review audits* Collaborates with Compliance Department on quality audits* Communicates with physicians and providers, and clients* Performs staff level training for clinical and non-clinical staff and respond to training level questions and inquires* Identifies process improvement initiatives* Develops training material, and job reference tools* Provide training to clinical and non-clinical staff on department processes, applications, and workflowsWhat are the requirements needed for this position?* Registered Nurse with active Arizona or Multi State RN licensure required* Minimum of 5 years of clinical experience* Minimum of 2 years of case management or care coordination experience or 2-3 years of utilization management experienceWhat other skills-experience would be helpful to have?* Preferred: Bachelor's Degree in Nursing* Preferred prior experience as a trainer or auditor* Knowledge of medical appropriateness criteria such as InterQual, Milliman Care Guidelines* Knowledge of case management standards of practice* Knowledge of CPT, ICD-10, and-or HCPC codes or coding experience* Knowledge of precertification and-or medical review processes in a health care payor or third-partyenvironment* Knowledge of URAC or NCQA standards* Excellent computer literacy and beginning to moderate skills level with Microsoft Word and Excel* Strong verbal and written communication skills* Capable of training others and able to serve as subject matter expert* Very good... For full info follow application link.Change Healthcare is an Equal Opportunity Employer. Employment at Change Healthcare is based upon your individual merit and qualifications. We don't discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability.