Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and/or proprietary business systems, updates or creates course materials to reflect changes in processes or systems and manages the department training effectively to ensure efficient and effective learning.  Ensures that educational programs meets with all compliance, regulatory and contractual requirements.  Conducts ongoing audit review programs, develops tools to assess current outcomes and trends along with Directors, Managers and Supervisors.  Develops educational interventions to maintain contractually mandated standards of care as it applies to existing and future Policies, Workflows, and Systems functions. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review.  Develops ongoing educational programs that ensures clinical and non-clinical staff are evaluated at designated intervals to maintain proficiency level that meets Contractual and Regulatory Requirements as well as individual productivity measures.  The incumbent requires a knowledge base that integrates clinical and technical systems training to ensure that business functions/processes are in compliance with NCQA Regulations and ongoing contractual directives.  Delivers highly complex training courses and workshops in support of workforce development, technology and/or proprietary business systems, updates and/or creates  course materials to reflect changes in processes or systems and manages and leads the classroom effectively to ensure learning.

ESSENTIAL RESPONSIBILITIES

• New Hire Onboarding Monthly and PRN- Responsible for the Coordination of all duties associated with the new hire onboarding process, programs, materials and execution. Will be responsible for Human Resource Orientation, all line of business training, Operating platform training. Following new hires through ongoing audit/education over the initial 3 month hire period.  Collaborates closely with Supervisors and Managers of department on staff progress and assists with remediation plans as indicated.  Responsible for coordinating new hire training schedules with preceptors and Supervisors. Ongoing assessment of the program, revisions as Business, Regulatory, Accrediting Body or Contractual as needs evolve and/or are identified.
• Conduct ongoing assessment and training for current staff based on an ongoing assessment of the program with any revisions that maybe needed associated with Business, Regulatory, Accrediting Body or Contractual identified needs. Responsible for annual competency programs for all staff to ensure that we maintain best practice levels of care.
• Identify audit trends/issues with associated program development, to ensure adherence to all departmental polices and procedures. Collaborate and communicate with Supervisors/ Managers throughout the year.
• Coordinate with relevant team members to evaluate impact of ongoing Policy development as it impacts the need for associated workflows and staff education. 
• Act as a SME in association with Operating Platform Development as it impacts clinical and non clinical workflows/training/documentation. Participation in system testing and regression testing to identify any gaps in function as it applies to the staff ability to meet all mandated Business/Regulatory or Contractual obligations. 
• Other duties as assigned.

EDUCATION

Required

• High School diploma/GED

Substitutions

• None

Preferred

• Bachelor's degree in Nursing
• Bachelor's degree in Social Work

EXPERIENCE

Required

• 3 - 5 years in Case Management

Preferred

• 5 - 7 years in Nursing
• 5 - 7 years in Social Work

LICENSES OR CERTIFICATIONS

Required

• Required (any of the following):

• Registered Nurse

• Licensed Social Worker (LSW) – Non-Specific

• Licensed Clinical Social Worker (LCSW) - Non-Specific

• Licensed Master Social Worker (LMSW) – Non-Specific State

• Licensed Professional Counselor (LPC) – Non-Specific State

• Licensed Mental Health Counselor (LMHC) – Non-Specific State

• Licensed Marriage and Family Therapist (LMFT) – Non-Specific

• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

Preferred

• ACM Certification (Accredited Case Manager)

SKILLS

• Adult Learning: Theory and Practice
• Creativity Skills
• Clinical Systems
• Company Presentations
• Medicaid
• Project Management
• PowerPoint

Languages (other than English)

• None

Travel Required

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Constantly

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$57,700.00

Pay Range Maximum:

$107,800.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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