Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

Responsibilities and Qualifications

The Clinical Development Education Consultant is responsible for the planning, direction, coordination, execution and evaluation of educational programs supporting clinical staff and functions. This position works with clinical leadership, quality, compliance and human resources to ensure the successful creation and implementation of onboarding and training programs for all clinical new hires as well as developing and managing the continuing education, training, and professional development initiatives. Additionally, this role is responsible for partnering with leadership on workflow development and maintenance for the various teams within the department.

Manages the education and programmatic information necessary to perform job responsibilities in accordance with corporate policy as well as regulatory and accreditation requirements. Ensuring all clinical staff are in compliance with regulations and requirements through comprehensive training strategies and measuring staff understanding.

Manages the process for clinical competency evaluation for ongoing and provision of continuing education as it relates to clinical programs and best practice, policies and procedures, as well as competency evaluation for new personnel.

Plans, organizes, evaluates, and maintains orientation/onboarding process for new clinical employees and communicates progress to leadership, recommending remediation as appropriate and documenting completion of orientation, competencies and mandatory trainings.

Mentors and assists clinical staff with identification of available continuing education and professional development opportunities and requirements as applicable.

Align clinical educational content with current regulations, accreditation standards, and organizational policies.

Provides targeted education in support of regulatory audits, accreditation surveys, and corrective action plans.

Attends company and departmental meetings and training sessions as required.

Identify training needs and develop educational materials based on results of audits, Inter-Rater Reliability Assessments, and quality findings.

Provide one-on-one and group consultation to address performance gaps, documentation quality, and decision consistency.

Recommend improvements to processes and educational strategies based on data and best practices.

Facilitate program (i.e. TruCare) based trainings to clinical staff.

Skills:

• Strong organizational, problem solving, documentation, and communication skills, with the ability to successfully engage others.
• Ability to translate complex regulations into practical, understandable training.
• Approachable, Adaptable and Flexible to change and new or unexpected circumstances.
• Ability to manage multiple conflicting priorities in a fast-paced environment.
• High level of comfort with clinical documentation systems.
• Demonstrated effective public speaking and written communication skills.
• Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.

Knowledge:

• Keeps abreast of developing trends, knowledge, and skills related to health plan principles and clinical best practices.
• Knowledge of adult learning principles, motivational interviewing, intrinsic coaching techniques and education/training strategies.
• Experience supporting CMS, NCQA, or state regulatory audits.
• Experience developing educational content.
• Knowledge of clinical and managed care principles and operations.

Experience:

• Minimum of 5 years of Utilization Management experience in a health plan, managed care organization, or similar setting.
• Minimum 5 years’ experience in an acute care setting.
• Minimum of 3 years demonstrated experience in education, training, coaching, or professional development.
• Experience in health insurance, or other related healthcare field preferred.

Education and Certifications:

• Registered Nurse with active licensure in PA or Enhanced Nurse Licensure Compact (eNLC) multistate licensure in home state.
• Bachelor’s degree in Nursing or higher required; bachelor’s degree in business, education, or a health related field accepted.
• Masters degree preferred.
• InterQual® certification is strongly preferred or willing to obtain when offered.

Physical Demands:

Sedentary work involving significant periods of sitting, talking, listening, typing and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.