Manager of Clinical Education & Quality

Now is the time to join us! 

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Who are you?

Responsible for the overall clinical training and quality assurance aspects of the Utilization Review, Case Management, Nurturing Together, and Disease Management departments.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Creates and maintains formal training curriculum that ensures process best practices, compliance adherence, and quality goals and objectives of the department/processes as assigned by management.
• Conducts training orientation, introduction to process specific training to prepare the clinical and non-clinical staff on their assignments as scheduled.
• Deliver effective training in multiple modalities (classroom, virtual, self-learning, 1 on 1) to adult learners of varying experience and skill sets and in different formats—oral, written and tactical.
• Participate in reporting mechanism findings to gauge training efficacy, such as surveys and feedback related to training.
• Maintains formal record of training activities and employee progress (track and trend) and updates the training department leadership on any Clinician that are not meeting expectations.
• Create quality audit programs based on training effectiveness with analysis on how to improve process and procedure with policy in place.
• Conducts sample reviews with quality analysis audit for each staff member on a monthly basis at a minimum and identifies any adherence gaps and training opportunities.
• Provide training and support in correlation to team member for performance improvement.
• Does research and maintains high-level of understanding of regulations to support staff education plans.
• Remain current with best practice models and current processes to be able to provide instruction to staff.
• Maintains high-level of cohesiveness within the team and professionalism as a representative of the training department.
• Other related duties as assigned to meet departmental and Company objectives
• Attend and participate in all mandatory department and training meetings as assigned by the Director of Case management.
• Provide direction and oversight of the training team performance based or presentation and metrics.
• Assign specific and area wide training to training team as needed by the department.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• RN Licensure required
• Certifications in managed care or case management or other certification appropriate to the self-insured space.
• Bachelor’s Degree preferred, or minimum seven years of formal training experience in health care service capacity as it relates to case management, utilization management and/or chronic disease management.
• Proven successful training practices and techniques, ability to implement principles of adult learning required
• UR, CM, DM experience required.
• Managed care experience required.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Knowledge of clinical and non-clinical practices within a health plan and insurance provider environment with emphasis on self-insured and knowledge of CMS (Centers for Medicaid and Medicare Services)
• Strong communication skills with speaking, writing and presentation skills, including policy and procedure.
• Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements
• Knowledge of ERISA, Department of Labor, Federal, State, URAC, NCQA, required.
• Critical thinking, ease in communicating in formal and informal settings, excellent documentation skills (Excel, Word, email, in-person)
• Strong initiative with strategic thought in creating and scaling for growth and innovation.
• Ability to work independently daily in multiple locations if needed and in different mediums.
• Ability to analyze information and convert related activities into a comprehensive work plan
• Assures compliance with the recommendations of the Quality improvement committee ( QIC) regarding activities, projects, and reports.
• Responsible for monitoring ongoing compliance with URAC Standards, state, and federal regulations.
• Responsible for providing a comprehensive initial orientation and training of staff,
• Assessing learning needs of the staff and creating/ facilitating programs to meet those needs.
• Oversees the Quality Program in the implementation of the Quality management program (QMP ) Activities with the help of the coordinator.
• Helps develops the work plan with the assistance of the QIC members
• Helps work with management, Medical Directors, and the Quality improvement committee (QIC) to develop and implement the projects and activities to be monitored.
• Assures compliance with the QIC recommendations and activities as indicated.
• Is responsible for the coordinator delivering an annual review to be presented to the QIC. The annual review includes analysis of the overall effectiveness of the quality management program. Key aspects included in the annual review include:
  • Program Descriptions
  • Quality Policy Statement
  • Quality Work Plan & Evaluation
  • Marketing Review
  • Policies & Procedures
  • Metric Indicator / Statistics Reporting
  • Trending and analysis of improvements in clinical management
  • Service quality and other operational accomplishments

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $90,000 to $106,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.