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CIGNA

RN Quality Training Manager / Quality Management Sr Spec - (Nashville OR Philadelphia preferred loca)

CIGNA - Nashville, TN

RN Quality Training Manager / Quality Management Sr Spec - (Nashville OR Philadelphia preferred loca

Cigna

Nashville

TN

Job #673434090

Description:

Essential Duties and Responsibilities

•Manage and update the Quality Improvement program to Precert Staff. Audit documentation generated through the calls and develop quality and performance measurements.

•Manage a remote team of Trainer / Quality Reviewer based in different market and maintain unique “customer experience” in the team across market.

•Responsible for the analysis of quality measurements to simplify and/or improve processes, as well as tracking and trending data to determine performance standards.

•Monitor, track and provide monthly Highlights and findings about following 3 components: Denial Letters, Quality and Training.

•Works closely with the corporate training department to determine additional training needs including management training, reference materials, job aides, coaching, communication, etc.

•Works closely with PreCert leadership team to assure we are meeting their needs and provide them adequate feedback about their staff.

•Works closely with your peers to maintain consistency, avoid duplication and share best practice across the team, which include Non-Clinical, Clinical, Complaince, C-Kit pages information, PPAL and data analytic resources.

•Provide constructive feedback to individuals or groups regarding audit findings and coach the staff on appropriate departmental processes and guidelines to facilitate process improvements.

•Develops and maintains all necessary training scenario applications for the Health Services department.

•Providing new and existing staff with training and conducting training in variety of modalities, including role playing, simulations, team exercises and group discussions. Monitors and measures staff training progress and development

•Facilitates performance improvement plans for identified personnel and makes recommendations to Health Services leadership in areas of process and performance improvement strategies for both individuals and teams.

•Actively participates in all staff meetings.

Knowledge, Skills, Abilities Required :

•Advance knowledge of the Precert Process

•Knowledge and ability to train on Precert processes

•Advance knowledge of Utilization Review principles

•Knowledge of Medicare Review Criteria and ability to train the trainer on how to use the criteria.

•Ability to identify and analyze problems and recommend solutions.

•Possess excellent analytical skills.

•Extensive knowledge of medical management processes including authorization rules and contracting methodology.

•Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners, Executive Leadership, and other health workers involved in the care of a member

•Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments

•Able to work in a dynamic, fast-paced team environment and to promote team concepts

•Proficiency with Excel and with analytical tools, knowledge of data analysis methodology, use of presentation software.

•High Degree of knowledge of formal and informal departmental goals, standards, policies and procedures which may include some familiarity of other departments within the organization.

•Ability to work well independently and with little need for supervision.

Qualifications:

Qualifications

•Registered Nurse required (RN)

•Managed care experience, preferably in utilization review or utilization management.

•Minimum three years experienced in facilitating training to adult learners.

•Minimum three years’ experience in development of training programs for clinical staff.

•Minimum three years auditing experience

•Minimum three years’ experience managing people

•Must have quality performance and improvement experience

•Prefer formal education and/or certifications in Adult Learning and/or Instructional Systems Design.

•Extensive knowledge of medical necessity criteria (e.g., NCD, LCD, InterQual, Milliman)

Computer Skills

•Substantial knowledge of Microsoft Office including Outlook, Power point (advanced level required), Excel and Word.

Primary Location:

Nashville-Tennessee

Work Locations:

500 Great Circle Road Nashville 37228

Job:

Med Mgt--Clinical Qual Mgmt

Schedule:

Regular

Shift:

Standard

Employee Status:

Manager of People

Job Type:

Full-time

Job Level:

Day Job

Travel:

Yes, 50 % of the Time

Job Posting:

May 24, 2018, 3:45:16 PM

Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: ~~~

Updated 05/25/2018

18 days 10 hours ago

CIGNA

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RN Quality Training Manager / Quality Management Sr Spec - (Nashville OR Philadelphia preferred loca) CIGNA - Nashville, TN, United States

   

Location: Nashville, TN

Company Profile:
Cigna works with employers and organizations around the world helping employees stay healthy and on the job. We work closely with brokers and consultants to develop innovative programs, help individuals and families improve their health, well-being and sense of security—and lower their medical costs. And, Cigna provides access to a global network of local physicians and hospitals—as well as 24/7/365 live customer service.