Corewell Health
RNMedicalUtilizationManagementEducator
“RN Medical Utilization Management Educator at Corewell Health. Skills: Utilization Management, Education, RN. Coordinates the educational plan for the Behavioral Health, Care Management, and Utilization Management departments. Develops/implements the educational plan for Behavioral Health, Care Management, and Utilization Management”
What You'll Achieve.
Analysis of outcomes from external audits; Analyze and evaluate the effectiveness of all educational activities; Reporting outcomes
Industry & Context.
Rounding and telephonic support of staff education needs and problem solving
MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category
What They're Looking For.
Must Have
Registered Nurse (RN) - State of Michigan Upon Hire, 3 years of relevant experience, 3 to 5 years' experience in Care Management, or Utilization Management
Nice to Have
Master's Degree, Utilization Management experience highly preferred, Education and/or training experience highly preferred
What You'll Do.
Coordinates the educational plan for the Behavioral Health
and Utilization Management departments
Develops/implements the educational plan for Behavioral Health
and Utilization Management
Develops/implements orientation of new staff which is comprehensive and individualized with one-on-one training for three or more weeks
Rounding and telephonic support of staff education needs and problem solving
Ongoing education based on analysis of outcomes from external audits
Education and support for implementation and ongoing use of new electronic medical record system and supplemental ancillary computer systems
Conducts department-specific assessment for educational needs related to Compliance Monitoring and Education
Monthly auditing of Compliance Risk areas and identification of staff education and documentation needs to ensure compliance
Annual education on InterQual ® criteria changes with annual Interrater Reliability Assessment
Analyze and evaluate the effectiveness of all educational activities
Conducts educational workshops to medical management and related audiences as requested
Education of changes and payor requirements to targeted Physician groups
Develops informational materials and/or other media to be distributed to internal/external customers
Maintains and updates repositories of educational content needed for staff orientation
day-to-day operations
and continuing education on Sharepoint sites
Develops annual education plan to ensure Care and Utilization management staff have access to current best practice and relevant updates
Monthly auditing for specific areas of focus as directed by leadership
to ensure adherence to clinical best practice
Department Liaison for external audits
Coordinates and facilitates with other departments to ensure readiness for audits
Analyze audit recommendations
Reporting outcomes and development/implementation of staff education as needed
Assists with project and program improvement efforts
How You'll Work.
Team & Collaboration
In conjunction with Medical Management leadership, coordinates the educational plan; Stakeholders include staff, physicians, department leadership, and third-party vendors; Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with matrix reporting to other areas in Medical Management; Collaborate with educators to Provide education and support as needed; Coordinates and facilitates with other departments to ensure readiness for audits
Communication Scope
Develops informational materials and/or other media to be distributed to internal/external customers; Education of changes and payor requirements to targeted Physician groups
Process & Methodology
Assists with project and program improvement efforts
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