UM Trainer

  • Utilization Management
  • Fort Lauderdale, FL/ Hybrid
  • 2 months ago
  • 1 available

Job Description

Responsible for the training of all UM personnel to ensure compliance with policies and procedures. To ensure that protocols are followed with regard to provider contracts, member benefit schedules, established guidelines, and departmental policies and procedures.  Develop employee on-boarding training programs as well as on-going skills training for technological updates or other operational changes, plan, coordinate and conduct training exercises.

Essential Functions & Responsibilities

  • Training and guidance to the UM Department Staff on their daily responsibilities in the department for quality and productivity purposes.
  • Confer with management, supervisors and employees to gain knowledge of work situations requiring training and to better understand changes in policies, procedures, regulations, business initiatives and technologies.
  • Coordinate training schedule with the hiring and training demands of department.
  • Participates in, and conducts technical training programs. Determines training objectives.
  • In collaboration with the department management, writes training programs, including outline, text, handouts, Manuals and post-tests, and designs laboratory exercises to measure that learning objectives are met or identifies new training needs as applicable.
  • Conducts training sessions covering specified areas such as on the job training, refresher training, etcetera.
  • Test trainees to measure progress and to evaluate effectiveness of training.
  • Report on progress of employees under guidance during training periods, assist employees with problems concerning “how to” perform specific tasks. Make suggestions on improving work procedures.
  • Develop strong relationships with all UM Coordinators, Team Leaders and UM Management.
  • Performs periodic reviews of authorization to identify training needs of individuals and team in general.
  • Administers written and practical exams and writes performance reports to evaluate trainees' performance.
  • Creates, maintains, and upholds the weekly, monthly & annual audit reports of the UM staff performance to UM management.
  • Review, process and adjust referrals as needed
  • Support UM Coordinators on the pending referral requests
  • Coordinates with Team Leaders and UM management and conducts in-service sessions to the UM staff in order to address departmental processes.
  • Recognizes referral issues/problems, refers them to management and/or appropriate party and assists in the review and implementation of resolution.
  • Assists management and all staff in their daily work as needed or necessary

Required Education and Experience

  • High School diploma or equivalent required.
  • Minimum 5-10 years of Employee Training Production, Minimum 3 years experience in a UM processing environment preferred .
  • Demonstrated knowledge of ICD-910 CPT-4, HCPCS coding and medical terminology
  • Subject Matter Expert on data entry system, processes, workflows, and requirements