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Clinical Group Health Trainer

1 hour, 21 minutes ago
United States
Full-time
Senior
Training Manager
Operations
Apply Now
Dane Street

Dane Street

Dane Street provides independent medical examination and peer review services tailored for the insurance industry, focusing on areas such as workers' compensation, disability, and auto liability, while emphasizing quality, compliance, and timely delive...

Insurance
251-1K
Founded 2008
View All Jobs 20

Description

  • Onboard and train new QA hires until they meet readiness criteria for integration into the operations team.
  • Monitor clarification rates, turnaround times, and daily output to identify training and remediation opportunities.
  • Review daily operational reports and collaborate with leadership on employee goals and performance trends.
  • Serve as a resource for team members on operational questions, problem-solving, and escalation support.
  • Lead bi-weekly clarification and TAT review meetings by pulling data, facilitating discussion, and issuing remediation plans.
  • Conduct regular MFR workshop training sessions and develop onboarding agendas with Ops Leadership.
  • Coordinate and track annual client regulatory training requirements and support accreditation audits such as NCQA and URAC.
  • Provide backup support for QA Supervisors and the GH Auditor on invoicing, board balance, and client collaboration audits.
  • Create, update, and maintain training documentation, severity trackers, and client-change trackers.
  • Partner with managers and supervisors on remediation plans, 90-day reviews, annual evaluations, and PIPs.

Requirements

  • RN or LPN license required.
  • Strong background in clinical operations, training, or quality assurance.
  • Extensive experience in utilization review and health plan practices.
  • Experience navigating CMS requirements, health plan criteria, and nationally recognized guidelines such as MCG and InterQual.
  • Proficiency in rationale writing and translating clinical content into patient-friendly language.
  • Excellent communication, coaching, mentoring, and client collaboration skills.
  • Ability to analyze data, identify trends, and drive performance improvements.
  • Proficiency with Google Suite, communication platforms, and related applications.
  • Preferred experience with benefit denials, medical necessity reviews, EIU reviews, criteria-only reviews, formulary exception reviews, quantity limit reviews, step therapy reviews, inpatient vs observation reviews, level of care reviews, claims reviews, payment integrity reviews, DRG validation, quality of care reviews, and fraud, waste, and abuse (FWA) reviews.
  • Strong working knowledge of relevant guidelines, medical terminology, critical thinking, time management, computer literacy, and typing skills.
  • Ability to perform job duties that may involve lifting, bending, traveling, long periods of sitting, and extended computer work.
  • Reliable uninterrupted internet service is required for this work-from-home role.

Benefits

  • Medical, dental, and vision coverage for employees and their families.
  • Voluntary life insurance options for employees, spouses, and children.
  • Additional voluntary coverage including hospital indemnity, critical illness, accident indemnity, and pet insurance.
  • Employer-paid basic life insurance, short-term disability, and long-term disability coverage.
  • Generous paid time off.
  • 401(k) plan with company match.
  • Apple equipment and a media stipend provided for the remote workspace.

Interested in this position?

Apply directly on the company website

Apply Now

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