UM Trainer

Description

NOTE: THIS POSITION HAS THE ABILITY TO WORK REMOTELY UNTIL FURTHER NOTICE!  

Innovista Health Solutions is an Illinois-based service organization with management services operations in Illinois and Texas. We are currently looking for a Utilization Management Trainer out of our Oak Brook, IL office. At Innovista, we believe that positive forward movement in today’s uncertain healthcare market stems from the combination of innovative programs and dedicated people. Join the Innovista team and lead the charge to a better, more efficient healthcare system. 

JOB SUMMARY: 

The Utilization Management Nurse Trainer is responsible for the new employee orientation and subsequent training of all Utilization Management Clinical Staff, to ensure clinical accuracy of applying criteria for Pre-Service and Concurrent Review, as well as correctly entering requests for services or items into the Authorization platform. The position will also include auditing new employees and current staff, as needed along with providing timely feedback. 

The Utilization Management Nurse Trainer supports the business objective by performing Utilization Management Nurse duties when Utilization Management Nurses are on PTO or out of the office. The Utilization Management Nurse Trainer instructs compliance with all corporate policies, CMS guidelines, state regulatory guidelines, health plan requirements, departmental policies and job aides, and others as needed. The position maintains oversight of New Employee Orientation Checklists. The Utilization Management Nurse Trainer oversees the creation, implementation and scoring for all Inter-Rater Reliability testing on an annual or semi-annual basis. 

DUTIES AND RESPONSIBILITIES:  

• Responsible for New Employee Orientation training.
• Maintain all New Employee Orientation Training Tools and Schedules.
• Identify all New Employee barriers to learning Utilization Management concepts, while training through the audit process and provide feedback to management.
• Maintain knowledge of the UM Plan.
• Maintain knowledge of Departmental Polies and Procedures.
• Maintain proficiency in the Authorization Platform.
• Maintain proficiency with MCG or other platforms for clinical care guideline.
• Maintain knowledge of resources used by Utilization Management Nurses and where the resources can be located. 
• Create and Implement IRR testing for all Utilization Management Clinical Staff on an annual or semi-annual basis. 
• Instruct or retrain current staff on an as needed basis.
• Collaborate with departmental management to ensure training tools and training activities are up to date. 
• Perform Utilization Management Nurse duties when departmental staff is on PTO or out of the office.
• Performs other duties as assigned .

Requirements

• Registered Nurse with a current and active license to practice in the State assigned or maintain a compact license. 
• Bachelor’s degree or equivalent experience required.
• At least 3-4 years of relevant professional experience, including managed care and Utilization Management experience.
• At minimum of 3 years of clinical experience in a hospital, LTAC, skilled nursing facility, home health, hospice, or physician office setting.
• Knowledge of ICD-10 guidelines and appropriate clinical documentation.
• Knowledge of NCQA guidelines, MCG, NCD/LCD, and ASAM criteria.
• Demonstrate excellent organizational skills.
• Demonstrate effective verbal and written communication skills.
• Demonstrate analytic skills when problem solving.
• Proficient in MS Office Applications and ability to learn department and job specific software systems.
• Demonstrate high attention to detail and high degree of accuracy.
• Able to commit to Innovista’s corporate mission and values.
• Able to switch priorities in a positive and effective manner when directed by Company Leadership.
• Able to effectively communicate technical concepts with team members and basic business concepts with team members and internal customers.

BENEFITS:

Innovista is dedicated to hiring passionate individuals who embody our core values: integrity, determination, and teamwork. We recognize the importance of work-life integration and seek to provide our employees with competitive benefits, which include:

• Comprehensive health plan options, dental, and vision coverage subsidized by Innovista
• Opportunity to work from home, based on position and manager discretion
• Company-paid benefits, such as short- and long-term disability, employee life, and AD&D
• Discretionary bonus
• 401(k) with company match
• Opportunity for career advancement and growth
• Flex time options may be available

We do not post salary ranges. Salary ranges posted on other sites are not tied to our labor market specifications and are not relevant.