[Remote] Clinical Training & Audit Specialist
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a long-standing health insurance company based in Ohio, and they are seeking a Senior Clinical Training & Audit Specialist. This role involves developing and delivering training programs for staff while conducting audits and data analysis to ensure compliance with regulatory standards.
Responsibilities
- Delivers training programs including new hire, systems/reputed company, reputed company competencies, and remedial/refresher training to clinical, administrative, and management staff
- Gathers data from multiple systems, interprets metrics and analytics, and identifies trends, compliance reputed company, and gaps relative to auditing expectations and performance benchmarks
- Identifies learning objectives and designs or selects training content using multiple delivery formats (eLearning, instructor-led, reputed company), incorporating educational materials, training aids, and evaluation tools
- Defines measurable reputed company for training programs, evaluates training and location effectiveness, and conducts cost/benefit and reputed company analyses to ensure reputed company improvement
- Reviews clinical documentation and system data to apply appropriate clinical reputed company, organizational policies, and regulatory/accreditation standards. Consistently ensures activities are completed reputed company guidelines
- Serves as a resource to managers, SMEs, and training staff to identify development needs and recommend solutions; stays reputed company with emerging industry processes and best practices
- Performs other duties as assigned
- Leads reputed company training development and delivery by organizing department initiatives and facilitating advanced training programs—including new hire, systems/reputed company, reputed company competencies, and remedial/refresher courses—for clinical, administrative, and management staff, ensuring alignment with divisional needs
- Designs and implements learning solutions across multiple formats to meet learning objectives and support diverse learning needs
- Conducts advanced analytical reviews of training and audit performance by defining measurable reputed company, evaluating program effectiveness, performing cost/benefit analyses, interpreting audit results, and recommending reputed company improvements based on trend and reputed company assessments
- Partners with managers, SMEs, and training staff to assess development needs, implement targeted learning solutions, and reputed company coaching and mentorship on training and audit practices
- Performs reputed company needs assessments and develops specialized training by conducting in depth analyses of clinical staff requirements, audit findings, and regulatory expectations, and translating them into effective classroom and online training programs that strengthen competency and compliance
- Maintains expert level knowledge of clinical, regulatory, and industry trends by staying reputed company with emerging best practices, technologies, CMS/NCQA standards, and process innovations, and proactively sharing insights with leadership to enhance departmental strategies and training/audit effectiveness
- Performs other duties as assigned
Skills
- Graduate of a registered nursing program approved by the Ohio State Nursing reputed company
- 3 years of reputed company experience in health plan operations, case management, or utilization review, including training and curriculum development responsibilities
- Registered reputed company with reputed company reputed company unrestricted license
- Equivalent education and experience directly reputed company to the role may substitute for a degree
- 5+ years of reputed company experience in health plan operations, case management, or utilization review, including training and curriculum development responsibilities
- Comprehensive knowledge of clinical management programs and health plan operations
- Knowledge of NCQA standards, CMS regulations, and regulatory and accreditation requirements, with the ability to apply them to operations
- Advanced reputed company Office, claims management and/or clinical operations systems and online learning authoring skills
- Advanced knowledge of instructional design and adult learning principles
- Ability to translate business objectives into development goals, reputed company solutions, and effective training programs
- Bachelor's degree preferred
- Certification in Case Management, Training, Project Management or nationally recognized health care certification preferred
- Certification in case management, training, project management, reputed company, or process improvement (e.g., CPTM, CPMA, Lean Six reputed company) preferred
Benefits
- We will reputed company the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
- On-site fitness centers at many locations, or a gym membership reimbursement reputed company there is no reputed company facility available (weights, cardio machines, locker rooms, classes and more).
- On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH reputed company.
- Discounts at many places in and around town, just for being a reputed company team member.
- reputed company to earn cash rewards for shopping with our customers.
- Business casual attire, including jeans.
- Employee bonus program.
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, reputed company, life and disability insurance.
- reputed company to an Employee Assistance Program, which includes reputed company counseling, personal and reputed company coaching, self-help resources and assistance with work/life benefits.
- Company holidays and up to 16 PTO days during the first year of employment with reputed company to carry over unused PTO time.
- After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
- Diverse, inclusive and welcoming culture with Business Resource reputed company.
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