Lead Clinical Performance Coach Job
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Employer: Blue Shield of California
SpiderID: 14129512
Location: Rancho Cordova, California
Posted: 1/17/2026
Wage: Negotiable
Priority Review Date: 2/16/2026
Job Code / NOC / SOC: 17002FJ-2191
Category: Insurance
Job Description:
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
Job Details
Clinical Auditor/Coach will specialize in auditing and performance improvement for Medical Management Nurses (Case Managers, Utilization Managers or Post Service). Candidate will develop performance metrics and evaluate performance to ensure that continuous improvement of skills and knowledge required to be successful in various nursing roles in Medical Management. The Clinical Auditor/Coach adheres to California Continuing Education Provider requirements and URAC, NCQA and DMHC training standards. Ensures RNs are current on regulations through training provided in classroom setting, one-to-one, intranet and through competency training. Often acts as a resource resolving complex case issues or interpretation of department protocols and procedures.
Responsibilities:
• Performs audits and provides developmental coaching for clinical staff.
• Provides clinical coaching and support to all staff to improve skills and competencies required to successfully perform work.
• Designs, implements, evaluates and improves audit criteria and training courses/programs to meet clinical needs of Medical Management nurses.
• May independently represent the training department in Medical Management work re-design, process changes and software implementation
• Conducts/facilitates effective presentations relating to Medical Management processes and/or training for internal or external customers.
• Acts as a resource for the training and auditing team.
Location:
Preferred - Rancho Cordova, CA; Telecommuting option for all California residents
Qualifications:
Education/Requirements:
• Ability to provide direction and support to staff.
• Must have familiarity of Motivational Interviewing theory and practice.
• Experience in Case Management and Disease Management required.
• Strong organizational and/or project management skills to coordinate departmental projects & to perform multiple projects or tasks simultaneously
• Functions independently in classroom environment and lifecycle development activities.
• Subject matter expert w/capability to effectively train/audit all lines of business and 8 of the 10 clinical processes
• Current California RN license & 4+ years related experience and/or training, or equivalent combination
Minimum Experience Level:
• Current California RN license. At least 4 years training and/or auditing experience and at least 1 year experience in managed care or similar complex healthcare environment.
• Bachelors or advanced degree preferred
• Certified Case Manager (CCM ) &/or Certified Professional in Learning and Performance (CPLP) preferred
• Demonstrated skill with coordination of complex training requests and large classroom environments.
• Meets or exceeds Sr. minimum experience requirements.
Supervisory responsibilities:
• QA and regular performance audits.
• Training and mentoring
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
Job Details
Clinical Auditor/Coach will specialize in auditing and performance improvement for Medical Management Nurses (Case Managers, Utilization Managers or Post Service). Candidate will develop performance metrics and evaluate performance to ensure that continuous improvement of skills and knowledge required to be successful in various nursing roles in Medical Management. The Clinical Auditor/Coach adheres to California Continuing Education Provider requirements and URAC, NCQA and DMHC training standards. Ensures RNs are current on regulations through training provided in classroom setting, one-to-one, intranet and through competency training. Often acts as a resource resolving complex case issues or interpretation of department protocols and procedures.
Responsibilities:
• Performs audits and provides developmental coaching for clinical staff.
• Provides clinical coaching and support to all staff to improve skills and competencies required to successfully perform work.
• Designs, implements, evaluates and improves audit criteria and training courses/programs to meet clinical needs of Medical Management nurses.
• May independently represent the training department in Medical Management work re-design, process changes and software implementation
• Conducts/facilitates effective presentations relating to Medical Management processes and/or training for internal or external customers.
• Acts as a resource for the training and auditing team.
Location:
Preferred - Rancho Cordova, CA; Telecommuting option for all California residents
Qualifications:
Education/Requirements:
• Ability to provide direction and support to staff.
• Must have familiarity of Motivational Interviewing theory and practice.
• Experience in Case Management and Disease Management required.
• Strong organizational and/or project management skills to coordinate departmental projects & to perform multiple projects or tasks simultaneously
• Functions independently in classroom environment and lifecycle development activities.
• Subject matter expert w/capability to effectively train/audit all lines of business and 8 of the 10 clinical processes
• Current California RN license & 4+ years related experience and/or training, or equivalent combination
Minimum Experience Level:
• Current California RN license. At least 4 years training and/or auditing experience and at least 1 year experience in managed care or similar complex healthcare environment.
• Bachelors or advanced degree preferred
• Certified Case Manager (CCM ) &/or Certified Professional in Learning and Performance (CPLP) preferred
• Demonstrated skill with coordination of complex training requests and large classroom environments.
• Meets or exceeds Sr. minimum experience requirements.
Supervisory responsibilities:
• QA and regular performance audits.
• Training and mentoring
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Experience:
Education:
Travel:
Vacation:
Contact Information:
| Contact Name: Blue Shield of California | Type: |
| Company: Blue Shield of California |