Clinical Utilization Review Trainer/Specialist job opportunity at Dane Street.

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Dane Street Clinical Utilization Review Trainer/Specialist
Experience: 2-years
Pattern: remote
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Salary:
Status:

Specialist

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degreeGraduate Certificate
United States Of America

MAJOR DUTIES & RESPONSIBILITIES Onboard and train all new QA hires. New QAs will be ready for integration into the ops team when the following criteria are met: Proficiency on one core client (≤ 2% clarification rate) Division 1: HCSC Division 2: BCBS MN Division 3: Optum Daily output of ≥ 5 cases Collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals). Serve as a resource for team members regarding operational questions, concerns, and problem-solving. Provide backup #support to QA Supervisors as needed (e.g., invoicing, board balance). #Maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback. Participate in client calls. Lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans. Conduct regular MFR (member-friendly rationale) Workshop training sessions. #Develop onboarding agendas in consultation with Ops Leadership. Identify and schedule training opportunities/meetings. Coordinate and track annual client regulatory training requirements.

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