PLEASE NOTE: Before applying, please be sure that you:
· Hold an active California RN license
· Have recent Utilization Management experience, specifically outpatient Prior Authorization experience
We will not be able to consider candidates without the above requirements.
The Health Services Nurse Educator RN II works under the guidance of a Manager or Director of the Department as required. The Health Services Nurse Educator RN II is responsible for conducting functional and technical training across all Health Services Departments in alignment with departmental policies and procedures. This position will coordinate and/or provide training with the onboarding of new hires. This position is responsible for ongoing training, education, and remediation for experienced staff. The position must be a subject matter expert in utilization/case management process and standards of practice including, but not limited to community, professional, and industry standards. This position serves as the chief instructor and consultant for operational, reporting, and accrediting requirements for all lines of business.
This position will support the team in ensuring quality and compliance with the regulations and requirements of state, federal, and accrediting agencies. This position will influence operations and help support in the implantation of standards. This position will conduct educational needs assessments across all lines of business perform instructional analysis, develop timeline/ training tools/resources to ensure training materials are compliant with professional utilization management and case manager standards of practice, quality, evidenced based outcomes, regulations, and accrediting guidelines. In addition, this position will assist with knowledge transfer, and “Train-the-Trainer” programs.
Responsibilities
- Partners with Leadership to develop and maintain project plans for developed courses, including new hire onboarding training for Health Services departments.
- Collaborates with department leadership in assessing training materials, designing and developing training programs, preparing training schedules, establishing training/ educational goals/ objectives; and conducting initial and ongoing evaluations of such.
- Responsible for developing staff training for technology/systems that support the work of Health Services staff.
- Applies alternative training mediums and methods (self-study, online, blended, simulations) to increase training effectiveness and to accommodate distance learning, learning style and cultural differences.
- Writes behavioral objectives, tests, training methodology, and course materials using instructional design theory and modalities.
- Manages databases and instructional hardware/software for documentation, testing, and maintaining all training materials including eLearning modules, scenarios, job aids and course materials.
- Collaborates with and assist Health Services Nurse Educators across the various Health Services departments as needed.
- Partners with the Health Services Provider Support Services Department in the development of trainings and implementation.
- Works closely with Learning Technologies Administrator and provides backup as needed.
- Provides weekly progress reports and recommendations on learning plans to a designated department leader who determines the content and frequency of such reports.
- Coordinates nursing annual presentations, internal, and external educational opportunities. Provides oversight for all new CCMC certification applicants. Tracks and documents the progress of all staff matriculating in higher education programs.
- Responsible for keeping abreast of updates to community, professional and industry practice standards. Serves as a Lead Preceptor/Trainer to effectively deploy policy/procedure updates and regulatory requirements in a consistent and compliant manner. Actively contributes in updates to and maintenance of organizational policies and procedures as it pertains to Utilization Management and Case/Care Management. Regularly performs quality check updates in policies, procedures, job aides, and other materials to ensure regulatory compliance and implementation.
- Conducts monthly and quarterly audits as per National Committee for Quality Assurance (NCQA) and Department of Health Care Services (DHCS) requirements, as well as CMSA Standards of Practice, to ensure L.A. Care adherence to all requirements. Provides monthly audit reports to Supervisors, Managers, and Director. Applies audit data to the development and improvement of training programs.
- Responsible for coordinating reviews and preparing for internal and regulatory audits of Utilization and Case Management records; analyzing audit findings; making recommendations for corrective action plans; and implementing internal and external corrective action plans as it pertains to education and training of staff.
- Collaborates with leadership to develop a standardized process for team member audits and rebuttal as well as an audit tool.
- Develop a competency-based orientation for all Health Services job descriptions. Partners with other Subject Matter Experts within LA Care to coordinate department educational opportunities. Collaborates with internal and external partners to plan/ facilitate/ execute the educational and training goals of the department and organization including, but not limited to, the Provider Support Services Department and HR.
- Perform other duties as assigned.
Required Qualifications:
- A minimum of 5 years of experience in designing, developing, and delivering in-person and online training courses; or any combination of education and experience which would provide the required knowledge, skills, and abilities.
- At least 3 years of responsible work experience in Utilization and/or Care Management (in an acute or managed care setting, and/or in training and education).
- Knowledge and experience with eLearning tools and internet technology.
Preferred Qualifications:
- Experience working in a health care setting strongly preferred.