Clinical Trainer RN, Utilization Management - Southwestern Health Resources, SWHR

Qualifications

Education

Associates Degree Required
Bachelor's Degree Nursing Preferred Or
Master's Degree Nursing Preferred

Experience
4 Years Medicare Advantage or Managed Care Required AND
4 Years Clinical education, or Case Management experience in an acute or post-acute provider or other managed care company Required AND
2 Years Utilization Review, Discharge Planning and Medical Case Management in a hospital or post-acute care setting Preferred

Licenses and Certifications
RN - Registered Nurse Upon Hire Required AND
CCM - Certified Case Manager Upon Hire Preferred

Skills
Working knowledge of computers and basic software applications used in job functions such as word processing, graphics, databases, spreadsheets, etc.
Strong analytical and organizational skills. Working knowledge and ability to apply professional standards of practice in work environment.
Knowledge of specific regulatory and managed care requirements.
Demonstrates proficiency in the application of health plan coverage guidelines, CMS coverage guidelines, and nationally recognized review criteria.
Demonstrates a solid understanding of managed care trends Medicare, and Medicaid regulations, reimbursement and the effect on utilization and outcomes of the different methods of reimbursement.

Position Responsibilities of a SWHR Clinical Trainer Registered Nurse (RN) is:

Ongoing training and education:

• Provides standardized training programs for staff to improve quality and ensure compliance with state and federal regulations and guidelines.
• Responsible for evaluation of training effectiveness to ensure staff understanding and readiness.

Educates staff on SWHR programs and systems:

• Provides nursing staff with clinical and educational support and guidance for the implementation of Southwestern Health Resources (SWHR) UM/CM processes.
• Educate licensed staff regarding proper clinical judgment and approaches to proper decision making.
• Provides training for current staff for new programs or key initiatives.
• Provided training for system implementations and upgrades.
• Reeducates staff when deficiencies in performance are identified.
• Updates job aides and SOPs as needed and ensures proper storage of documents.

Development of Training Curriculum:

• Responsible for the development and implementation of training curriculum for Utilization Management staff and interrater reliability (IRR).
• Works with leadership team to ensure state specific regulations are included in training materials.
• Assists in eliminating boundaries to achieve integrated, efficient, and quality service.
• Collaborate with Clinical Management Team to identify specific clinical educational needs and Identify clinical educational needs of clinical and non-clinical staff.

Compliance:

• Serves as a resource to employees and customers as demonstrated by visibility and knowledge of issues.
• Oversees and coordinates the process and education for all clinical practice programs, i.e., CEU opportunities.
• Comply with all compliance, regulatory and process training within the specified timeline.
• Completes documentation in applicable software system accurately and in accordance with:
• eligibility and benefits
• clinical guidelines/criteria
• legal and regulatory requirements

Onboarding:

• Implements new employee orientation for health care service staff.
• Assists new staff with on-boarding, including initial set up of computer systems and various accesses required for each employee's job.
• Performs other duties as assigned to support the education/QA initiatives departmental-wide

In addition to the required qualifications, a successful SWHR Clinical Trainer Registered Nurse (RN) will:

Working knowledge of computers and basic software applications used in job functions such as word processing, graphics, databases, spreadsheets, etc.
Strong analytical and organizational skills. Working knowledge and ability to apply professional standards of practice in work environment.
Knowledge of specific regulatory and managed care requirements.
Demonstrates proficiency in the application of health plan coverage guidelines, CMS coverage guidelines, and nationally recognized review criteria.
Demonstrates a solid understanding of managed care trends Medicare, and Medicaid regulations, reimbursement and the effect on utilization and outcomes of the different methods of reimbursement.

Why Southwestern Health Resources 
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other.  To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

We invite you to learn more about us at www.southwesternhealth.org.

Let’s move healthcare forward – together.

Highlights:

• Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
• SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.

Additional perks of being a SWHR Clinical Trainer Registered Nurse (RN):

• Gain a sense of accomplishment by contributing in a teamwork environment
• Positively impact patients’ quality of life
• Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
• Enjoy opportunities for growth

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.