Nurse Educator RN

molina healthcare has an immediate opportunity for a Nurse Educator RN at our Troy, MI location. This role 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 Healthcare Services team to assess quality and implement clinical training programs to facilitate standardized delivery of services and provide optimal outcomes for Molina Healthcare Members. Duties and Responsibilities

• Assess the Health Plans Integrated Healthcare Services teams clinical and regulatory educational needs.
• Evaluate the clinical staff skill level and competency in the delivery of the clinical programs in the health plan.
• Work with Corporate Director of Training and Implementation to develop standardized materials for training purposes.
• Provide needed training programs and classes to improve and maintain staff level of clinical excellence to distinguish Molina from competitors.
• Implement training and mentoring for new staff and new system implementation.
• Provide Healthplan staff with opportunities for training including Molina developed or outside clinical in-services, and staff coaching.
• Maintain compliance with clinical training programs in conjunction with program requirements, and Federal and State regulations.
• Conduct Quality Improvement Audits to assess Molina Healthcare Services staff educational needs and service quality.
• Provides clear and timely verbal and written feedback of issues to team members and management. Reeducates employees when deficiencies in performance are identified.
• Conducts annual inter-rater reliability session and reports results.
• Provides input to management on annual evaluations.
• Records and trends individual and department review results on weekly, monthly, quarterly and annualized basis.
• Conduct self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Acts as an information and problem solving resource for Molina Healthcare Services team members.
• Complies with required workplace safety standards.
• Other duties as assigned

Knowledge, Skills and Abilities

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Knowledge of adult educational/learning theory and practice.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• In depth knowledge of NCQA, Interqual and Molina Guidelines and Processes.
• Knowledge of state and federal regulatory requirements.
• Ability to take initiative and see tasks to completion.
• Computer skills and experienced user of Microsoft Office software.
• Excellent verbal and written communication skills.
• Ability to abide by Molinas policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

QUALIFICATIONS Required Education

• Registered Nurse with a Bachelors degree (equivalent combination of experience/education will be considered in lieu of Degree).
• Masters degree in Nursing, Public Health/Education or health related field preferred

Required Experience

• 3+ years of managed care experience and one year or more of healthcare training and/or quality management experience
• 3+ years in a training, auditing and/or quality management role in a Medicaid/Medicare Managed Care Environment preferred

Required Licensure/Certification Active, unrestricted State Registered Nursing license in good standing Preferred Licensure/Certification Active, unrestricted State Registered Nursing license in good standing. Certified Clinical Coder, Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Medical Audit Specialist (CMAS), Certified Professional in Health Care Quality (cphq), or other healthcare or management certification. Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V  RequirementsSee Job Description
Country: USA, State: Michigan, City: Troy, Company: Molina Healthcare Inc..