Medical Management Educator

Grand Rapids, MI - USA

Monthly Salary: Not Disclosed

Posted on: 5 hours ago

Vacancies: 1 Vacancy

Job Summary

Registered Nurse OR Social Worker

Scope of work:

In conjunction with Medical Management leadership coordinates the educational plan for the Behavioral Health Care Management and Utilization Management departments. Stakeholders include staff physicians department leadership and third-party vendors. Uses specific age and culture-related physical intellectual psychological and development attributes in the educational plans for staff. Reports to either a Director of Behavioral Health Care Management or Utilization Management with matrix reporting to other areas in Medical Management.

Develops/implements the educational plan for Behavioral Health Care Management and Utilization Management.
Develops/implements orientation of new staff which is comprehensive and individualized with one-on-one training for three or more weeks.
Rounding and telephonic support of staff education needs and problem solving.
Ongoing education based on analysis of outcomes from external audits.
Education and support for implementation and ongoing use of new electronic medical record system and supplemental ancillary computer systems.
Collaborate with educators to Provide education and support as needed.
Conducts department-specific assessment for educational needs related to Compliance Monitoring and Education.
Monthly auditing of Compliance Risk areas and identification of staff education and documentation needs to ensure compliance
Annual education on InterQual criteria changes with annual Interrater Reliability Assessment.
Analyze and evaluate the effectiveness of all educational activities.
Conducts educational workshops to medical management and related audiences as requested.
Education of changes and payor requirements to targeted Physician groups.
Develops informational materials and/or other media to be distributed to internal/external customers.
Internal/external orientation material.
Maintains and updates repositories of educational content needed for staff orientation day-to-day operations and continuing education on Sharepoint sites.
Develops annual education plan to ensure Care and Utilization management staff have access to current best practice and relevant updates.
Monthly auditing for specific areas of focus as directed by leadership to ensure adherence to clinical best practice.
Department Liaison for external audits.
Coordinates and facilitates with other departments to ensure readiness for audits
Analyze audit recommendations
Reporting outcomes and development/implementation of staff education as needed.
Assists with project and program improvement efforts

Qualifications

Required Bachelors Degree
Preferred Masters Degree

3 years of relevant experience Must have 3 to 5 years experience in Behavioral Health Care Management or Utilization Management. Required
Related position(s); education and/or training experience. Preferred

Registered Nurse (RN) - State of Michigan Upon Hire required Or
Master Social Worker (MSW-Master) - State of Michigan Upon Hire required

How Corewell Health cares for you

Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Utilization Management Operations

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

Required Experience:

Registered Nurse OR Social WorkerScope of work: In conjunction with Medical Management leadership coordinates the educational plan for the Behavioral Health Care Management and Utilization Management departments. Stakeholders include staff physicians department leadership and third-party vendors. Us...