System Educator Care Coordination/Utilization Review

Role Overview:

The System Educator of Care Coordination and Utilization Review is responsible for developing, implementing, and maintaining education and training programs across the organization’s care coordination and utilization review teams. This role ensures consistency in knowledge, skills, and practices systemwide, aligns training initiatives with organizational goals and supports staff development to optimize patient outcomes, regulatory compliance and financial performance.

DUTIES & ESSENTIAL JOB FUNCTIONS:  NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

• Develop and deliver orientation programs for new hires in care management and utilization review.
• Create, update, and maintain training materials, policies, and procedures to align with evidence-based practices and regulatory requirements.
• Organize ongoing educational sessions, workshops, and certifications to ensure staff competency and professional growth.
• Leverage technology to deliver training through E-Learning platforms, webinars, and in-person sessions.
• Ensure staff are educated on current federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.
• Provide training on documentation standards to support compliance and appropriate reimbursement.
• Stay current on industry trends, policy changes, and best practices, and incorporate them into training programs.
• Assess staff competency and identify knowledge gaps through audits, feedback, and performance reviews.
• Develop individualized training plans to address areas of improvement.
• Collaborate with leadership to ensure training programs address system-wide performance metrics, such as length of stay (LOS), avoidable readmissions, and denial prevention.
• Serve as a resource and advisor to care coordination and utilization review teams across the system.
• Collaborate with clinical leaders, IT teams, and external vendors to optimize educational tools and systems.
• Facilitate communication between departments to ensure alignment and consistency in care coordination practices.
• Lead training initiatives aimed at improving care transitions, reducing avoidable readmissions, and enhancing patient satisfaction.
• Support utilization review efforts by educating staff on medical necessity criteria, denial management, and appeals processes.
• Evaluate the effectiveness of educational programs and update them based on staff feedback, performance data, and organizational needs.

Qualifications:

• Required Education: Bachelor’s degree in Nursing
• Preferred Education: Master’s degree in Nursing
• Required Experience: Five years of Case Management experience in an acute care setting
• Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,
• Active BLS - Basic Life Support Certification issued by the American Heart Association

FLSA Status & Representation:

• FLSA Status: Exempt
• Representation: Unrepresented