Job Description

POSITION SUMMARY/RESPONSIBILITIES
Serves as a Manager to the Community First Health Plan (CFHP) Clinical Services support staff. Also serves as the clinical expert, educator, researcher and mentor to the Clinical Services team. Reviews healthcare service delivery and provides standardized training programs for plan staff to improve quality, control medical costs and ensure compliance with all state and federal regulations and guidelines. Collaborates with the integrated team to assess quality and implement clinical training programs to facilitate standardized delivery of services and provide optimal outcomes for CFHP Members. Responsibilities include, but are not limited to: day-to-day management of assigned support staff; prepare, facilitate, monitor, evaluate and document training activities; assess training needs for new and existing employees; identify internal and external training programs to address competency gaps; partner with internal stakeholders regarding employee training needs; and, develop training aids such as manuals and handbooks.

EDUCATION/EXPERIENCE
Registered Nurse licensure is required. Master's degree is highly preferred. Certification in health or education field highly preferred. Minimum six (6) years of clinical care, quality management or managed care experience is required. Knowledge of InterQual screening criteria and coding resources (DRG, ICD and CPT) is required. Knowledge of Medicaid, community resources, alternate funding programs, Texas Health and Human Services Commission and Texas Department of Insurance standards and NCQA in a managed care setting is required. Demonstration of experience in curriculum development and implementation of adult learning principles is preferred. Demonstrated teaching experience and knowledge of adult education principles, ability to deliver and evaluate adult education programs is preferred. Minimum of two (2) years of management and/or teaching experience is required, preferably in a healthcare environment, providing training and support to users of industry-standard PC systems and applications and other job-specific applications. Direct, recent experience with electronic learning development, curriculum design, training methodologies, and online education is preferred.

LICENSURE/CERTIFICATION
Current licensure in the State of Texas as an RN is required. Current certification from an appropriate professional agency, such as Case Management Society, is highly preferred.

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