Job Details

Job Opportunity At Highmark Inc.

Job Summary: This job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and/or proprietary business systems, updates or creates course materials to reflect changes in processes or systems and manages the department training effectively to ensure efficient and effective learning. Ensures that educational programs meet with all compliance, regulatory and contractual requirements. Conducts ongoing audit review programs, develops tools to assess current outcomes and trends along with Directors, Managers and Supervisors. Develops educational interventions to maintain contractually mandated standards of care as it applies to existing and future Policies, Workflows, and Systems functions. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review. Develops ongoing educational programs that ensures clinical and non-clinical staff are evaluated at designated intervals to maintain proficiency level that meets Contractual and Regulatory Requirements as well as individual productivity measures. The incumbent requires a knowledge base that integrates clinical and technical systems training to ensure that business functions/processes are in compliance with NCQA Regulations and ongoing contractual directives. Delivers highly complex training courses and workshops in support of workforce development, technology and/or proprietary business systems, updates and/or creates course materials to reflect changes in processes or systems and manages and leads the classroom effectively to ensure learning.

Essential Responsibilities:

• New Hire Onboarding Monthly and PRN- Responsible for the coordination of all duties associated with the new hire onboarding process, programs, materials and execution. Will be responsible for Human Resource Orientation, all line of business training, Operating platform training. Following new hires through ongoing audit/education over the initial 3 month hire period. Collaborates closely with Supervisors and Managers of department on staff progress and assists with remediation plans as indicated. Responsible for coordinating new hire training schedules with preceptors and Supervisors. Ongoing assessment of the program, revisions as Business, Regulatory, Accrediting Body or Contractual as needs evolve and/or are identified.
• Conduct ongoing assessment and training for current staff based on an ongoing assessment of the program with any revisions that maybe needed associated with Business, Regulatory, Accrediting Body or Contractual identified needs. Responsible for annual competency programs for all staff to ensure that we maintain best practice levels of care.
• Identify audit trends/issues with associated program development, to ensure adherence to all departmental polices and procedures. Collaborate and communicate with Supervisors/ Managers throughout the year.
• Coordinate with relevant team members to evaluate impact of ongoing Policy development as it impacts the need for associated workflows and staff education.
• Act as a SME in association with Operating Platform Development as it impacts clinical and non clinical workflows/training/documentation. Participation in system testing and regression testing to identify any gaps in function as it applies to the staff ability to meet all mandated Business/Regulatory or Contractual obligations.
• Other duties as assigned.

Education:

• Required: High School diploma/GED
• Substitutions: None
• Preferred: Bachelor's degree in Nursing, Bachelor's degree in Social Work

Experience:

• Required: 3 - 5 years in Case Management
• Preferred: 5 - 7 years in Nursing, 5 - 7 years in Social Work

Licenses or Certifications:

• Required: Registered Nurse or Licensed Clinical Social Worker (LCSW) - Non-Specific
• Preferred: ACM Certification (Accredited Case Manager)

Skills:

• Adult Learning: Theory and Practice
• Creativity Skills
• Clinical Systems
• Company Presentations
• Medicaid
• Project Management
• PowerPoint

Languages (other than English): None

Travel Required: 25% - 50%

Physical, Mental Demands and Working Conditions:

• Position Type: Office-Based Teaches / trains others regularly
• Constantly Travel: regularly from the office to various work sites or from site-to-site
• Rarely Works: primarily out-of-the-office selling products/services (sales employees)
• Physical work site required: Yes
• Lifting: up to 10 pounds
• Lifting: 10 to 25 pounds
• Lifting: 25 to 50 pounds

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Pay Range Minimum: $57,700.00

Pay Range Maximum: $107,800.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users.