Case Management Training and Quality Auditor

TRAINING & QUALITY AUDITOR

POSITION SUMMARY
This position will participate in the conceptualization, development, and execution of training programs. Deliver engaging, informative, and motivating training activities. Collaborate with internal departments to implement quarterly "refreshers." Additionally, perform quality and risk management evaluation and analysis, regulatory and compliance responsibilities through collaboration with the Data Analyst.

ESSENTIAL FUNCTIONS
• Develop course content, core competencies, evaluation tools, and materials for training activities
• Manage quarterly updates of reference materials for proprietary strategies and other assigned areas
• Proposes and implements recommendations for improved processes including the identification of training requirements, training gap analysis, and employee needs assessment/s
• Designs, delivers and responds to development requests from other departments
• Organize and facilitate the onboarding of department new hires
• Facilitates, and reviews audit results from all department teams; audits consist of any entry made related to a member
• Identify and analyze case impacts for Allied Care Medical Management Reporting to ensure content represents overall member engagement to further enhance client retention and assist in marketing to new business
• Perform audits of department-related claims, specifically CVS Caremark, limited distribution drug arrangements, transplant, and miscellaneous claims processed by the Enhanced Case Management Advocate to ensure appropriate payment is made
• Identifies department-wide trends and offers suggestions for improvement and or additional areas of focus
• Collaborate with Data Analyst in data gathering, analysis, and reporting metrics as needed
• Collaborate with Data Analyst to identify enhancements that will improve processes and support future business needs
• Other duties as assigned

EDUCATION
• Bachelors degree or equivalent work experience required.

EXPERIENCE & SKILLS
• 2 years of training experience required, preferably in healthcare or social service industry
• Comfortable with medical terminology
• Strong verbal and written communication skills
• Ability to collaborate with internal and external stakeholders
• Intermediate level experience with Microsoft Suite products, including Office, Word, Excel, Access and Power Point
• Ability to function well in a high-paced and at times stressful environment

POSITION COMPETENCIES
• Job Knowledge
• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus

PHYSICAL DEMANDS
• This is a standard desk role - long periods of sitting and working on a computer are required.

WORK ENVIRONMENT
• Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

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