The trainer assists in maintaining clinical quality standards by performing underwriting audits and identifying training needs for staff. They also develop educational materials and provide clinical guidance to ensure best practices are followed.
At the direction of the Supervisor, Quality & Training, assists in the overall clinical quality and clinical standards in LTCG’s case underwriting area. Performs random on-going quality audits for the underwriting staff, identifies and assists with training needs, clinical criteria review and external audits.
Complete regular underwriting decision quality audits for all clients as well as internal ad hoc audits. Provides written feedback to the underwriter and supervisor as indicated. Provides quality feedback to underwriting leadership at the time of performance appraisals for exempt level underwriting staff. Provides written quality audit summaries, reporting to clients as required by contract language (weekly, monthly or quarterly) and participates in client discussions regarding quality and audits.
Assist to identify training needs, develop teaching materials, and provide training to clinical staff based on the quality review, changes in clinical practice, on-going education needs, or new staff.
May assist with case consults for all levels of underwriters either verbally or written
Using clinical knowledge and underwriting expertise, assists with best practice and criteria manual reviews making recommendations for changes as indicated
Assists to update and maintain:
PHI & F2F assessment tools
ICD-9/ ICD-10 coding schemes in LTCAS & CLTCAS
Drug lists in LTCAS & CLTCAS
Assist on ad hoc projects as requested
Qualifications
Knowledge, Skills & Abilities
Conducts the quality assurance review of individual underwriters within written guidelines
Has knowledge of all client protocols and processes to evaluate the performance of others
Prefer a minimum of 24-36 months of Lead Underwriter level experience, or equivalent, based on overall job performance
Customer focused toward internal and external clients
Flexible with the ability to work on multiple tasks · Detail oriented with excellent organizational skills
Good interpersonal skills, with excellent written and verbal communication skills
Ability to analyze processes and implement innovative ideas to improve efficiencies
Demonstrated leadership abilities and team player
Demonstrated problem solving and decision making skills
Comprehensive knowledge of computer skills including word processing and use of Windows
EDUCATION/EXPERIENCE
Knowledge of long term care needs of individuals
Knowledge of life insurance and combo products in underwriting capacity
5 years Senior Level underwriting experience
Five or more years’ recent work experience in a related area that includes long term care, home health care or acute care
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