Clinical Trainer and Auditor - Case Management Experience - Remote-AZ

About this role

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This remote work opportunity requires residency, and work to be performed, within the State of Arizona.  

PURPOSE OF THE JOB • Responsible for designing, delivering, and evaluating clinical training programs and audit activities that promote standardized clinical decision-making, regulatory compliance and quality improvement across Utilization Management and Care Management initiatives. • This role supports staff development, onboarding, inter-rater reliability, and ongoing education for clinical teams to enhance performance, operational consistency, and achievement of organizational goals and initiatives.

QUALIFICATIONS

REQUIRED QUALIFICATIONS Required Work Experience • 5 years of direct clinical care experience in a healthcare setting • 2 years of experience in Utilization Management, Care Management, Health Management, Disease Management, or other managed care operations. • 4 years of experience in clinical training, education, auditing, or quality improvement, preferably in managed care.

Required Education •  Associate degree in general field of study or Post High School Nursing Diploma 

Required Licenses • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.),or RDN (Registered Dietitian Nutritionist), CDCES (Certified Diabetes Care and Education Specialist), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN.

Required Certifications • N/A

PREFERRED QUALIFICATIONS Preferred Work Experience • 5 years of experience in clinical education, training, auditing, quality improvement, and instructional design in either Utilization Management or Case Management. • 1 year of experience working with Milliman Care Guidelines (MCG), and / or other clinical criteria/guidelines. • Experience conducting clinical audits, quality reviews, or inter-rater reliability assessments related to evidence- based clinical decision making, documentation accuracy, and regulatory or accreditation standards. • Experience supporting onboarding, staff development, remediation, or performance improvement initiatives for clinical staff.

Preferred Education • Master’s degree in nursing, Master of Science, Social Work, Behavioral Health, Psychology, or another related clinical field.

Preferred Certifications • Active and current certifications such as: Certified Case Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), Board Certified Behavior Analyst (BCBA), or a Utilization Management Certification related to evidence-based clinical criteria such as MCG.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Develop and deliver training and education for clinical staff on clinical philosophy, evidence-based practice, documentation standards, regulatory requirements, and operational workflows related to Utilization Management, Care Management and Health Management. • Assess and prioritize training needs based on workflow changes, audit findings, stakeholder feedback, business priorities, and staff readiness. • Evaluate training effectiveness using feedback, knowledge checks, audit trends, and performance data to identify gaps and recommend improvements. • Assist with the development and evaluation of performance goals, quality management activities, and improvement initiatives that support clinical, operational, and regulatory standards. • Coordinate onboarding and training readiness activities, including system access, required resources, non-clinical checklists, and resolution of technical barriers. • Perform quality audits for Utilization Management activities and medical director determinations to evaluate consistency, accuracy, and compliance in evidence-based clinical decision-making, including inter-rater reliability assessments for Utilization Management as applicable. Audit activities assess whether medical director’s determinations are clear, concise, and documented to support clinical reviewers’ understanding and next-step action. • Perform quality audits

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