Sr Nurse - Clin Review
Sr Nurse - Clin Review
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Job Description
Conducts training for staff members pertaining to Utilization Review process clinical rules/guidelines client/module/modality-specific workflows and software enhancements
Creates educational material for review tiers by collaborating with key resources across departments to ensure clinical scenarios are properly incorporated into the educational content
Partners with Workforce Planning to develop training schedules conducive to achieving desired program specific outcomes
Proactively identifies targeted improvement opportunities
Partners with Human Resources and Clinical Operation leaders to highlight possible concerns amongst staff
Conducts focused training to ensure that all staff are properly educated on HealthHelp policies and clinical processes
Reviews monthly quality audit findings and conducts one-on-one coaching with staff to assist with resolving issues related to education and adherence to process and/or client-specific
directives
Leverages tools and methodologies to assess the effectiveness of educational content and delivery
Advises Leadership Teams/Medical Director of opportunities for individual performance improvement
Reviews reports from the Quality Department to identify training opportunities
Serves as contact point for staff in order to answer questions/provide clarification related to criteria policy and process
Partners with Products to develop training material designed to promote process efficiency and desired program-specific outcomes
Recognizes and informs management of process/performance gaps and offers solutions
Adheres to all regulatory requirements and complies with HealthHelp policies and procedures
Upholds professional standards and performs all work in a manner respectful of others
Provides a high level of service and support to both internal and external clients
Promotes business focus which demonstrates an understanding of the companys vision mission and strategy
Performs other duties as assigned to meet business needs
Qualifications :
Graduate of an accredited school of nursing required
Current active and unrestricted RN LVN or LPN license in a state or territory of the U.S. required
2 years of prior experience in direct clinical care or managed care setting required
1 year of direct virtual and/or face-to-face training experience required
1 year of Utilization Management Case Management or Clinical Care Coordination preferred
Remote education/training experience preferred
Ability to flex work hours based on business needs
Excellent listening oral and written communication/presentation skills
Ability to communicate complex information in a clear and concise manner
Strong problem solving interpersonal and customer service skills in both face-to-face and remote settings
Ability to work on multiple projects simultaneously and prioritize work to meet adapting deadlines
Ability to recognize potential and actual problems and work effectively within a team to develop appropriate solutions and implement effective action plans to address the problems
Ability to effectively perform in a fast-paced environment
Demonstrated knowledge and experience in using critical thinking skills
Proficient with Microsoft Office Suite and Windows products
Proficient with setting up webinars and multi-participant conference calls
Additional Information :
HealthHelp provides equal opportunities to all employees and applicants without regard to race color religion gender sexual orientation gender identity or expression national origin age disability genetic information marital status amnesty or status as a covered veteran in accordance with applicable federal state and local laws. If you need assistance in completing this application due to a disability please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing
Remote Work :
Yes
Employment Type :
Full-time
Employment Type
Remote
