I.JOB SUMMARYUnder the supervision and direction of the Clinical Team Manager/Supervisor or the Clinical Operations Manager, the primary objective of the Clinical Trainer position is todeliver initial and on-going clinical training including but not limited to program-specific training, Utilization Management (UM), Utilization Review (UR), state, federal, and client protocols related to scope of work of the staff. The Clinical Trainer will participate in the identification, conceptualization, implementation and execution of Quality Improvement Plans/Programs (QIP), Inter-Rater Reliability Testing to aid in the overall general improvement of performance of the staff.I.ESSENTIAL DUTIES and RESPONSIBILITIES
Deliver clinical training programs for new nurses and provide cross-training of senior/veteran nurses on new programs/domains.
Provide ongoing clinical training and development as services change.
Coach and monitor performance on an on-going basis to ensure high quality of performance.
Work with and coach the Quality Support Group and Operations team as necessary.
Participates in design of monitoring form and quality standards
Participates in calibration and Inter-Rater Reliability sessions (IRR) with QA group, Clinical Operations and the client.
Maintains proper documentation of all work completed and reports trending analysis daily/weekly/monthly as deemed necessary.
Use the appropriate system(s) required for the program to gather information and answer program specific questions relevant to scope of work.
Suggests methods for improving quality of work of the staff being monitored.
Performs routine monitoring and evaluation of, but not limited to the following: calls (inbound and/or outbound), utilization management (UM) cases, utilization review (UR) cases, and/or medical case review of the clinical staff who perform the same nature of work.
Focuses on the nurse’s clinical rationale following the approved federal/state/client clinical guidelines/protocols
Provides feedback to support medical recommendation when necessary.
Consults with the clinical Team Lead/Supervisor, and/or the medical director for proper guidance on clinical questions/concerns/clarifications clinical cases being reviewed.
JOB QUALIFICATIONS and REQUIREMENTS:Must be aPhilippine Registered Nurse (PHRN)
Must have at least three (3) years of clinical BPO experience in any of or similar domains of Utilization Management, Case Management, Disease Management, Wellness, Medical Coding and Billing, Pharmacy Benefits Management, Claims Management in any of the U.S. industry sectors of Workers’ Compensation; Commercial Managed Care; Health, Disability, Life, Property and Casualty Insurance; Accountable Care Organizations (ACO’s) or any other sector wherein the work performed is related to the use of clinical knowledge and skills.
Willing to work in Cupang, Muntinlupa.
Job Type: Full-timeSalary: Php30,000.00 to Php40,000.00 /monthExperience:Clinical Training: 3 years (Required)
License:Philippine Registered Nurse (Required)
