Job Description :
I. GENERAL OVERVIEW:
This individual is responsible for activities related to clinical education and training within Health Management Services (HMS) and Medical Management and Policy (MM&P) departments. This extensive role supports utilization management, the primary nurse model which includes health information line support, health promotion, health coaching and case management. Additional responsibilities include: development of orientation protocols, staff assessment, educational program development, resource development, motivational interviewing, and principles of self-management, principles of health coaching and case management, member web based information as well as instruction in utilization management criteria.
This individual is an integral component of HMS and MM&P, supporting the Clinical Directors and Managers in achieving training objectives. The Training Specialist – Clinical job requires excellent clinical, system and industry knowledge.
II. ESSENTIAL RESPONSIBILITIES:
1. Provide comprehensive education and training for all clinical staff, existing and newly hired. Determine training needs, establish course objectives, develop, test and conduct training programs for clinical staff. These should be based on job functionalities and regulatory requirements, as well as uphold Highmark’s mission and corporate values. This is to include new hire orientation, training on/coordinating training on systems, clinical criteria, regulatory standards, operational policies, system navigation, primary health coaching, business processes, utilization management business processes and guiding through corporate new hire requirements. Clinical educational programs may include evidence-based medicine protocols, motivational interviewing, health coaching, and more.
2. Provide comprehensive orientation for all newly hired health coaches and care managers. Working closely with the management team this individual is responsible for corporate and departmental mandatory training and ensures new hire training goals and objectives are met. As well as ensuring classroom material is kept up to date and availability to all staff.
Evaluate trainee performance both in the classroom and ongoing by assisting with quarterly quality audits, providing individual re-training when necessary.
3. Evaluate trainee performance both in the classroom and ongoing by assisting with quarterly quality audits, providing individual re-training when necessary. As well as evaluating training outcomes and make necessary changes in content or delivery as needed to ensure staff meets minimal high performance standards.
4. Provide subject matter expertise to all staff related to the care management platform for HMS and MM&P. In addition to the formal system training, this individual is considered the day to day navigational specialist.
5. Provide development and revision of all teaching manuals and job guides. Multi channel communication including staff presentations, Microsoft Outlook and web based programs are delivery vehicles. This individual will ensure that all mandatory training is communicated and available for staff throughout the year.
6. Provide subject matter expertise in the areas of regulatory and accrediting bodies such as CMS, NCQA, URAC, Department of Health, and Department of Labor. This individual will provide assistance in the preparation for regulatory and account audits and will maintain records of training offerings to be supplied to accrediting agencies and management.
7. Provide supplemental training and mentoring as need upon management request.
8. Other duties as assigned or requested.
• Bachelor’s Degree in Nursing with RN license or related health field such as Health Promotion, Health Education or Public Health
• 5-10 years of relevant, progressive experience in the area of specialization
• Clinical work experience
• Experience in one or a combination of: Health Coaching/Case Management/Utilization Management and development and implementation of educational programs
• Certification in Case Management
• Certification in Shared Decision Making
• Certification in Health Coaching
• Bachelor’s Degree in nursing
• Master’s Degree in psychology, social work or a related human services field
Knowledge, Skills and Abilities
• Expertise in Motivational Interviewing techniques, Health Coaching and/or Case Management principles
• Expertise in nationally recognized utilization management criteria
• Experience in Telephonic Coaching and/or Utilization Review Experience
• Advanced knowledge of clinical platform functionality
• Advance knowledge in Micro Soft applications
• Effective oral and written presentation/communication skills required.
• Evidence of effective interpersonal skills, systems knowledge, analytic skills with ability to create action plans, and ability to work independently to achieve targeted results.
• Self-motivated and independent performer with the ability to work independently and prioritize assignments. Ability to work effectively and drive programs to completion within a transforming organization.
• Ability to embrace change management; work effectively in a fast paced environment while managing multiple complex initiatives.
• Support an environment of continuous learning.
• Familiar with regulatory agency requirements, including but not limited to CMS, URAC, NCQA, DOL, and DOH.
IV. SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
V. WORK ENVIRONMENT
Is Travel Required?
Unusual Working Conditions
This position will work in the Pittsburgh HMS offices. There will be an occasional need to travel to remote staff or regional offices.
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.
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