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Senior Clinical Auditor/Trainer (RN)

Company: Centene Corporation
Location: Mcallen
Posted on: January 13, 2020

Job Description:

ProfessionalPosition Purpose: Develop, conduct, administer and analyze clinical training programs, conduct audits of clinical systems entry and/or processes, and assist in development of audit tools for Medicare and Medicaid.

  • Develop and conduct clinical education courses, including case management education and training for new employees
  • Develop and maintain complex audit processes and audit tools related to authorizations, appeals, quality, case management, inter-rater reliability and data entry
  • Audit established guidelines (e.g. Interqual) for medical necessity
  • Analyze training needs and identify, select or develop appropriate training programs including training aids and materials
  • Audit staff in accordance with established auditing processes, work with staff to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management
  • Train audit staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
  • Evaluate effectiveness of training programs including cost/benefit analyses
  • Research, analyze, and recommend internal/external training programs
  • Maintain records of training activities and employee progress
  • Assist with revisions to Policy and Procedure and/or work process development
  • Participate in Quality and Advisory committees or provider education meetings
  • Travel may be requiredEducation/Experience: Bachelors degree in Nursing, related clinical field or equivalent experience. 4+ years of experience in nursing, training, or auditing in a managed care healthcare setting. Experience in a lead or supervisory role preferred.License/Certification: Current state RN license. Drivers license may be required for certain positions.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.TITLE: Senior Clinical Auditor/Trainer (RN)LOCATION: McAllen, TexasREQNUMBER: 1171318COMPANY: TrainingPOSITION TYPE: Professional

Keywords: Centene Corporation, McAllen , Senior Clinical Auditor/Trainer (RN), Human Resources , Mcallen, Texas

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