Dane Street · 5 months ago
Clinical Utilization Review Trainer/Specialist
United States
Full-time
Remote
Mid LevelDane Street is a company that focuses on improving employee performance and client outcomes. The Clinical Utilization Review Trainer/Specialist is responsible for delivering structured training and ongoing education to new hires and current staff, while also identifying opportunities for learning and growth.
Auto InsuranceCommercial InsuranceEmployee BenefitsFinancial ServicesHealth InsuranceInsurance
Responsibilities
Onboard and train all new QA hires
Collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals)
Serve as a resource for team members regarding operational questions, concerns, and problem-solving
Provide backup support to QA Supervisors as needed (e.g., invoicing, board balance)
Maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback
Participate in client calls
Lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans
Conduct regular MFR (member-friendly rationale) Workshop training sessions
Develop onboarding agendas in consultation with Ops Leadership
Identify and schedule training opportunities/meetings
Coordinate and track annual client regulatory training requirements
Support regulatory accreditation audits (e.g., NCQA, URAC)
Provide backup support to GH Auditor in performing client collaboration audits (e.g., BCBSMN monthly, HCSC quarterly and annual)
Update and maintain severity and client-change trackers
Create and maintain training documentation
Collaborate on remediation plans for employees
Provide reviewer training when a Medical Director is unavailable; escalate issues to Medical Directors when appropriate
Partner with managers and supervisors to support 90-day reviews, annual evaluations, and PIPs
Other duties & special projects, as assigned and based on business needs
Qualification
Required
Proficiency on one core client (≤ 2% clarification rate)
Daily output of ≥ 5 cases
Ability to collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals)
Ability to serve as a resource for team members regarding operational questions, concerns, and problem-solving
Ability to provide backup support to QA Supervisors as needed (e.g., invoicing, board balance)
Ability to maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback
Ability to participate in client calls
Ability to lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans
Ability to conduct regular MFR (member-friendly rationale) Workshop training sessions
Ability to develop onboarding agendas in consultation with Ops Leadership
Ability to identify and schedule training opportunities/meetings
Ability to coordinate and track annual client regulatory training requirements
Ability to support regulatory accreditation audits (e.g., NCQA, URAC)
Ability to provide backup support to GH Auditor in performing client collaboration audits (e.g., BCBSMN monthly, HCSC quarterly and annual)
Ability to update and maintain severity and client-change trackers
Ability to create and maintain training documentation
Ability to collaborate on remediation plans for employees
Ability to provide reviewer training when a Medical Director is unavailable; escalate issues to Medical Directors when appropriate
Ability to partner with managers and supervisors to support 90-day reviews, annual evaluations, and PIPs
Ability to measure audit success: Measured by clarification rates, audit results, and daily/monthly TAT
Ability to measure remediation effectiveness: Measurable performance improvement within defined timelines
Ability to evaluate training success: Evaluated through 90-day and annual employee reviews, and check-ins with new hires (daily, weekly, monthly)
Company
Dane Street
Dane Street is an insurance company that offers review and evaluation services for workers compensation, health, and to some businesses.
Founded in 2008
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Josh Remillard
Chief Operating Officer
Greg Powers
Chief Marketing Officer/SVP Sales
Recent News
EIN Presswire
2025-07-23
2025-05-23
Company data provided by crunchbase