Clinical Quality Review Nurse Trainer/Auditor - Consultant

JOB DESCRIPTION
Your Role

The Clinical Quality Review (CQR) team is responsible for reviewing potential quality of care issues (PQIs) reported by a member, a member representative, or an internal partner. The Clinical Quality Review (CQR) Nurse Trainer/Auditor will report to the Senior Manager, Clinical Quality Review. In this role you will be responsible for understanding workflows, operational procedures, and Blue Shield of California policies to support the technical, cultural and process changes necessary for the Medicare, Commercial and Medi-Cal lines of businesses (LOBs). This position provides frontline support for nurses and coordinators and works in collaboration with leadership. The CQR Nurse Trainer/Auditor works closely with subject matter experts for each line of business (LOB) to facilitate educational and change management processes for implementation of changes as needed.

Your Work

In this role, you will:

• Design and develop effective learning and evaluation tools which support continued staff development
• Conduct periodic needs assessments to identify knowledge gaps
• Coordinate training activities with Medical Care Solutions
• Facilitate training which supports migration/launch of new system(s)
• Implement an assessment strategy for curriculum and track results and metrics
• Develop and conduct routine staff audits
• Monitor department and staff performance metrics
• Identify and document audit observations, findings and take appropriate action as indicated
• Assist with creating and updating training documentation, and policies and procedures
• Develop competency criteria for outcome mentoring, for staff for each line of business
• Meet with stakeholders to review solutions and issues and to gain commitment on recommendations
• Participate on multiple aspects of electronic medical record development
• Provide coaching and counseling to nurses and coordinators
• Provide input into evaluations regarding clinical competence
• Conduct systematic reviews for each LOB
• Develop and implement methods and processes in collaboration with the team
• Develop, implement, and evaluate training programs for nurses and coordinators and facilitate orientation processes for new hire staff
• Provide expert consultation and practice oversight
• Participate in performance improvement processes

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires a current California RN license
• Requires 3-5 plus years hands-on clinical experience across a variety of specialties and settings
• Preferred Nursing Informatics experience and/or degree
• Strong verbal/written communication and organizational skills
• Proficient in use of PC-based software programs including Microsoft Word, Excel, PowerPoint, and Outlook with strong typing skills required
• Ability to work independently in a fast-paced and fluid work environment
• Experience with, or strong working knowledge of, regulatory and accreditation agencies (DMHC, DHCS, CMS, NCQA) and managed care for various lines of business (HMO, PPO, Medicare, Medi-Cal, Cal Medi-Connect)
Consistent demonstration of knowledge, skills, abilities, and behaviors needed to provide superior and culturally sensitive service to team members, and contracted providers

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4 days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

COVID-19 Vaccination Policy:

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain accommodation within 30 days, your offer will be rescinded.