RN Care Management Training Programs Manager - Hybrid

About us:

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Training:

* Working in collaboration with Care Management Trainer, Leaders, and other business owners and subject matter experts to develop new hire and ongoing trainings via modules, PowerPoints, and other training formats creating and delivering content according to program policies/processes and models of care adhering to State and CMS guidelines

* Working in collaboration with Care Management Trainer, coordinates delegated organization's staff model of care training for products as required ensuring the care team staff employed at the delegated organization(s) are fully knowledgeable and able to complete care team processes as defined in specific product policies and processes, training on TruCare documentation and other Fallon Health resources and workflows to implement model(s) of care

* Coordinates the clinical new hire's training experience for the first six months of employment in conjunction with the Care Management Trainer and new hire leader often making face to face visits with the new hire in member homes to teach assessment processes, care pathways, and other workflows required by the Care Manager positions

* Works with Leaders to ensure the new hire is proficient in job role coordinating their new hire training schedule

* As required, works to implement additional teachings and experiences for the new hire/delegated organization(s) as indicated to ensure new hire competency success

* Develops and leads training/educational programs/modules intended to enhance the knowledge and efficiency of all care management staff ongoing in conjunction with the team leadership

* Obtains feedback from Care Management Leaders and staff on processes and staff understanding of such and develops training programs/strategies to ensure team member success in conjunction with the Care Management Trainer and Department Leaders

* Responsible for ensuring training tools such as Ready Reference and other resources are up to date, efficient, organized and of value for staff using in partnership with Care Management Trainer

* Works with Manager and team to actively coordinate and facilitate Corporate Trainings such as Grand Rounds and other opportunities for continuing education credit for various disciplines.

Auditing - Staff Competency:

* As part of training and ensuring competency and abilities, audits clinical documentation and ensures compliance to established competency

standards and regulatory needs, working in conjunction with staff and Department Leaders to improve team member (included delegated organizations) performance

Audits:
* Active participant in regulatory audits such as NCQA, CMS, State Contract Compliance and other audits representing the Care Team which includes preparing documents for submission, meeting with auditors and presenting case files including but not limited to demonstrating documentation as required in the documentation system

Other:
* Care Management Training Programs Manager behavioral health licensure is responsible to:

o Perform clinical supervision for Care Managers that have behavioral health backgrounds on a regular basis, supports and assists staff in becoming eligible for licensure exams and meets regularly with Fallon Health Behavioral Health Leaders for this responsibility
o Lead the Ethics Committee as required by Models of Care and regulatory agencies

Primary Job Responsibilities

Onboarding New Care Management Employees and Delegated Organization Care Team staff
o Conducts clinically focused training sessions, workshops and individual training sessions both in person and virtually

o Conducts initial orientation in conjunction with Care Management Trainer

o Collaborates with other business areas of Fallon Health to schedule guest speakers for orientation from the clinical aspect in conjunction with the Care Management Trainer

o Mentors and support new clinical care management employees during first 3-6 months of hire as additional point of contact

o Provides follow-up to orientation after 6 months to ensure clinical employees are meeting performance standards

o Communicates effectively with employees by phone, in person, or through electronic correspondence

Ongoing Training - Clinical Focus
o Collaborates with leaders to determine training needs and schedule training sessions

o Develops and implements competency programs to support cross-training of the clinicians to strengthen their ability to provide care within the whole-person care model- If BH licensed, BH competency program; RN- basic physical health competency program

o Conducts clinically focused training sessions, workshops and individual training sessions both in person and virtually

o Identifies areas where workflows are lacking or outdated and provide suggestions for improvement

o Maintains knowledge of instructional technologies by attending workshops; reviewing professional publications; establishing personal networks; participating in professional societies as able

o Proactively researches training content with Subject Matter Experts through interview techniques, review of existing documentation and job shadowing

o Supports with remediation training as part of performance plans as requested by leadership

o Maintains high level of current clinical knowledge and skills to ensure up-to-date education is provided to clinicians

o Collaborate with the Manager on identifying Clinical team CEU needs and implementing an in-house CEU program

Audit Function
o Audits clinical documentation, completing objective audit tools ensuring team member compliance with regulatory and accreditation requirements

o Audits documentation ensuring documentation meets quality standards and interventions and actions are effective to meet member needs

o Delivers audit result feedback to clinical staff and their leader and works in conjunction with the leader to implement leader developed team member corrective action plans when warranted

Administrative Duties
o Prepares training educational material such as presentations, handouts, best practices

o Designs, develops, and updates effective training programs

o Proofreads, edits, and maintains class materials and documentation to improve quality, readability, consistency, and effectiveness

o Works in collaboration with the Care Management Trainer to develop and implement a cohesive, effective training program for the entire team

o Creates and conducts evaluations to identify areas of improvement

o Keeps attendance and other records as required

o Maintains up to date knowledge of Fallon Health products and benefits, product specific Evidence of Coverage details, and department policies and processes

o Updates resource library to ensure all staff have access to the most up to date documents in partnership with Team

o Other duties as assigned by Leader

Education

Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing

License/Certifications

License: Active, unrestricted license as a Registered Nurse in Massachusetts
Certification: Certification in Case Management preferred
Other: Satisfactory Criminal Offender Record Information (CORI) results, reliable transportation

Experience

4+ years job experience as a Registered Nurse working in a care management/care coordination role in a managed care payor operating a dual Special Needs Plan required.

Experience with regulatory audits such as NCQA, CMS, State Contract Compliance and other audits representing the Care Team required.

Experience with NCQA, CMS, and other required regulatory requirements and experience writing and developing policies and process documents required.

Experience training clinical and non-clinical staff, and demonstrated knowledge of individual learning styles and ability to customize teaching methods to ensure learner success required.

Experience with developing audit tools, auditing team member performance, and working with staff to improve their performance preferred.

Demonstrated proficiency including but not limited to:
* Ability to develop a system and process to objectively measure care management competencies and to hold team members accountable, including, but not limited to developing corrective action plans, as appropriate
* Ability to identify gaps in staff's knowledge base and to design training materials to address those gaps
* Ability to teach others in an organized and structured manner utilizing adult learning principles and collaboration skills
* Exceptional interpersonal skills and willingness to continually modify training modules working in conjunction with subject matter experts to ensure training content is accurate
* Ability to recognize when training techniques are not effective and ability to adapt teaching style to meet learner's needs
* Ability to train on technical and non-technical business requirements, processes and service orientated responsibilities
* Advanced skills in software systems including but not limited to Microsoft Office Products - Excel, Outlook, and Word
* Manipulation of Excel spreadsheets to manage work and exposure and familiarity with pivot tables desirable
* Independent learning skills and success with various learning methodologies including but not limited to self-study, mentoring, classroom, and group education
* Exceptional customer service skills and willingness to assist ensuring timely resolution
* Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties
* Knowledgeable about community resources available to assist populations and staff with managing populations in the community and long-term care settings and demonstrated willingness to seek resources and expand knowledge to assist the population
* Knowledgeable about medical record documentation
* Critical thinking skills for independent problem solving

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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