Clinical Ops Education & Excellence Coordinator

• Participate in the implementation of the department’s training and audit strategy to support the achievement of Care Sources mission and business performance goals and national learning strategy
• Create, implement and evaluate utilization management and case management training programs and audit tools to support the development of CareSource employees, skills and competencies to help achieve business excellence
• Utilize a variety of educational media to ensure the right training is available to support the specific needs of multiple diverse audiences within areas of accountability
• Deliver training that successfully transfers learning from the classroom to the expected job functions and responsibilities of the learner
• Participate in the installation of new business relevant to area of responsibility and expertise
• Provide oversight, direction, and support for new staff orientation in conjunction with CSU and UM/CM preceptors
• Contributes /participates in process improvement meetings and initiatives
• Contribute to the development and implementation of quality improvement plan for utilization and care management providing recommendations based on clinical audit findings
• Develop and train utilization or care management specific education, mentoring and coaching to promote quality and consistency across the clinical ops functions
• Provide 1:1 coaching to CM/UM staff to promote consistency across clinical ops roles
• Review and analyze both automated and manual authorizations requests and decisions for trends
• Execute quality monitoring reviews of provider requests
• Execute quality monitoring reviews as defined by the Clinical Op’s Quality Monitoring Policy and Procedures (SOP’s) and e-Manuals
• Assist in identifying and evaluating any risk areas and provide input to the development of process improvements
• Perform quality monitoring procedures, education to staff to define issues
• Pursue development opportunities, including external and internal training, and share information gained with co-workers
• Perform any other job related duties as requested.

• Bachelor's Degree in Social Work, Health and Human Services or related field required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years of clinical experience required
• Training/teaching experience with demonstrated knowledge of adult learning and instructional design required
• Utilization Management or Case Management experience preferred
• Medicaid/Medicare or Commercial experience preferred

• Intermediate proficiency level with Microsoft Office Suite to include Word, Excel and PowerPoint Advanced proficiency with clinical documentation systems
• Ability to translate staff needs into a variety of learning and performance improvement strategies
• Excellent written and verbal communications skills
• Ability to create, evaluate and present department, role-focused materials across topics with excellent public speaking skills
• Ability to develop, prioritize and accomplish goals
• Listening and critical thinking skills
• Strong problem solving skills with attention to detail
• Strong interpersonal skills and high level of professionalism
• Knowledgeable in the prospective, retrospective and concurrent review process of inpatient admissions, outpatient procedures, homecare services and durable medical equipment
• Basic level of proficiency with data entry and internet skills
• Ability to work independently and within a team environment
• Familiarity of the healthcare field
• Proper grammar usage
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Strong organizational skills
• Change resiliency

• Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Professional Behavioral Health Clinical counselor (LPCC), or other similar professional healthcare related licensure or certification required
• Case Management certification or MCG certification is preferred for the role. Certification respective to your role must be obtained within a designated timeline.

• General office environment; may be required to sit or stand for extended periods of time
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources.
• Up to 15% (Occasional) travel based on the needs of the department may be required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business