Case Management Program Auditor and Trainer

Found in: Talent US C2 - 2 weeks ago

Smithfield, United States Neighborhood Health Plan of Rhode Island Full time

The Case Management Program Auditor and Trainer, under the direction of the Manager of Care Management,, oversees and reviews the performance of Case Managers and Community Care Coordinators who are receiving case management services from a Delegated Entity or Neighborhood in order to ensure quality and cost-effective member-centered care and adherence to contractual requirements. The position is responsible for collaborating with health plan leadership to identify training needs outside of the core curriculum to promote maximized effectiveness in managing behavioral and medical costs. This position will maintain and monitor the delivery and effectiveness of the training program and identify solutions to deficiencies.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

Administers a universal training curriculum for new employees, as well as ongoing training to maintain identified core competencies Develops and updates training curriculum based on clinical staff knowledge, needs, and areas of improvement needed as identified based on audit scores by senior leadership, staff request, or other business indicators and disseminate to staff as needed Understand cross-functional team processes to identify and solve system issues Participates in development, testing and implementation of new programs and systems Evaluates effectiveness of training tools in accordance with CMS requirements Completes monthly audits in accordance with meeting contractual requirements and communicate results to respective managers, identify gaps in training and implement improvements in training documents Prepares audit findings, documentation of deficiencies and communicates to manager Facilitates a response mechanism to individuals/teams for questions/concerns Reviews and recommends updates to policies and procedures within the Case Management department Responsible for staying abreast of product/member/provider issues, legislation, CMS mandates, policy changes and system changes so they can be considered for training topics Performs other duties as assigned by Manager Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

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