What are the responsibilities and job description for the Clinical Nurse Educator, Consultant (Behavioral Health) position at Blue Shield of California?
Your Role
The Medical Care Solutions education team is responsible for all clinical education for all departments within Medical Care Solutions as well as some Health Solutions teams. This includes Utilization Management, Care Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for all lines of business. The Clinical Educator position will report to the Senior Stakeholder Manager in Enterprise Learning supporting Health Solutions.
Your Work
In this role, you will:
- Manage and facilitate clinical education for new hires and existing clinical staff
- Support Utilization Management with a focus on new hire training and continuing education for Blue Shield of California clinicians working concurrent review and prior authorizations
- Conduct training classes in a virtual learning environment and at times in person
- Act as a liaison and provide training support and clinical education to clinicians
- Report any instances of noncompliance, such as access issues or quality concerns, to the appropriate department along with recommended corrective actions
- Partner will quality team and compliance to address quality trends or compliance issues that require training or education with a focus on DHCS, NCQA, and DMHC regulatory compliance
- Act as a Utilization Management clinical subject matter expert for Enterprise Learning guiding principles and processes
- Provide learning support and create Behavioral Health clinical learning scenarios
- Be a subject matter expert in MCG clinical criteria and BSC medical policies
- Clinical education on Utilization Management including concurrent reviews and prior authorizations
- Utilization Management concurrent review and prior authorization department processes and workflows
- Develop and design training modules for Utilization Management for all lines of business
- Create learning competencies checklists, mock case scenarios, and assessments as needed for Utilization Management reviews using MCG clinical guidelines and medical policies
- Support clinical learning projects and process improvements for Utilization Management (Concurrent Review and Prior Authorizations)
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires a current California RN license
- Requires at least 7 years of prior relevant experience
- Experience working in Utilization Management, preferred
- Experience in Health Insurance, preferred
- Experience and Knowledge in Behavioral Health, preferred
- Knowledge of learning principles and models, preferred
- Experience facilitating presentations using virtual technology, preferred
Pay Range:
The pay range for this role is: $ 109120.00 to $ 163680.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
Member-facing and approved out-of-state roles remain remote.
Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Salary : $109,120 - $163,680
