Trainer/Quality RN

Job Description

Trainer/Quality RN

Lead II - BPM

Who We Are

Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future—providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment and quality and provider engagement initiatives.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

UST is searching for a Trainer/Quality RN who will lead a team of customer support associates to achieve process outcomes, meet SLAs and manage client expectations. A Data Lead leads a team of process associates to achieve process outcomes, meet SLAs and manage client expectations. **

The Opportunity**

• Responsible for educating staff in managed care as it relates to department programs, processes, and systems.
• Conduct quality reviews on all precertification and Wellness, Care Management and Health Promotion cases.
• Develops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual criteria updates as needed.
• Oversee and mentor new employees during the initial training program.
• Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training.
• Educate staff and external provider facilities in the clinical policies criteria and procedures of InterQual as well as an overview of the department, general functions, responsibilities and department relationships with other departments.
• Prepare all training materials and develop training packages with related materials assigned by leadership.
• Participate in development, testing and implementation of new programs and systems as assigned.
• Share performance information with operations and training management in an effort to determine next steps.
• Coordinate administrative activities with the training supervisor and operations management, including class evaluations, updating files, class registration, scheduling classes, new hire system/software access, personnel information, and attendance management.
• Travel may be required.
• Responsibilities include providing clinical and educational support assessments, analysis and coordination of the quality management program and assisting in the divisional accreditation process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• Nursing Diploma or Associates Degree in Nursing required.
• Bachelor’s in nursing (BSN) or related fields preferred.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• CM certification preferred.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.
• Five (5) years experience in health-related fields required.
• Three (3) to five (5) years internal experience with Care Management.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• CM certification preferred.
• Effective analytical, verbal, and written communication skills
• Effective project management skills to create and execute work plans.
• Ability to work independently and in a team environment.
• Ability to manage multiple tasks.
• Proficient in relevant PC applications (Share point, Care Advance, NASCO, 3270, MCMS/AMP, CCDB, IKA and Portico system)
• Basic knowledge of ICD9/ICD 10 and CPT Codes
• MEDCO, Member Health Record, VDA (Virtual Desk Top), Care Advance
• Knowledge of local, state and federal regulations (PA250, PA350, DOL, ERISA, HIPPA)
• Leadership experience
• In depth understanding of BCBSM benefits and their application
• Ability to use clinical assessments and interventions.
• Knowledge of effective communication techniques and theories
• Knowledge of utilization management and InterQual criteria
• Must be willing to act as a “change agent” on behalf of Care Management and positively support the inception of new programs, systems, processes, software, and tools.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. **

Role Location: Remote**

Compensation Range: $60,000-$90,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST and its subsidiaries since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and place people at the center of everything we do. **

Humility**

We will listen, learn, be empathetic and help selflessly in our interactions with everyone. **

Humanity**

Through business, we will better the lives of those less fortunate than ourselves. **

Integrity**

We honor our commitments and act with responsibility in all our relationships. **

Equal Employment Opportunity Statement**

UST is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#Advantasure

#CB