Company :Highmark Inc.
Job Description :
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.
- 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 Delaware LOB 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. ollaborate and communicate with direct Highmark Health Options Supervisors/ Managers throughout the year.
- Coordinate with Senior Clinical Quality Management Analyst 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.
- Bachelor's degree in Nursing
- Bachelor's degree in Social Work
- 3 - 5 years in Case Management
- 5 - 7 years in Nursing
- 5 - 7 years in Social Work
LICENSES OR CERTIFICATIONS
- Registered Nurse
- Licensed Clinical Social Worker (LCSW) - Non-Specific
- ACM Certification (Accredited Case Manager)
- Adult Learning: Theory and Practice
- Creativity Skills
- Clinical Systems
- Company Presentations
- Project Management
Languages (other than English)
25% - 50%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
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.
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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf )
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