Training Specialist, Medical Review Audit – Clinical RN

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

The Training Specialist, Medical Review Audit – Clinical RN owns the design, development, and delivery of post acute training programs for clinical audit staff specializing in Inpatient Psychiatric Facility (IPF), Inpatient Rehabilitation Facility (IRF), Home Health and DME claims. This is not a generalist training role. The right candidate brings deep, working knowledge of IPF and IRF documentation standards, payment systems, and medical necessity criteria alongside a demonstrated track record of building training programs that produce measurable improvements in auditor accuracy, productivity, and quality outcomes. This role requires an active nurse who can function as both a clinical subject matter expert and a skilled adult learning practitioner.
Key Responsibilities to include:
Training Program Design & Development

- Design, build, and maintain comprehensive training curricula for clinical audit nurses and audit associates covering post acute claim review, documentation requirements, medical necessity criteria, coding, and payer policy.

- Develop structured training programs, job aids, reference materials, and assessment tools for new hire onboarding, ongoing competency, performance improvement, and new program implementations.

- Translate complex clinical, regulatory, and payer-specific requirements into clear, audit-ready training content appropriate for the intended audience — including IPF PPS, IRF PPS, DSM-5 diagnostic criteria, level of care distinctions, and facility-specific billing rules, and other relevant training.

- Maintain and update training materials on a continuous basis to reflect changes in CMS payment rules, LCD/NCD policy, coding guidelines, and client-specific requirements affecting IPF and IRF audits.

- Build and manage training content within the Learning Management System (LMS); ensure materials are current, accessible, and structured for effective delivery in a remote environment.

Training Delivery & Outcomes

- Plan, coordinate, and deliver new hire training and ongoing education across 1:1, small group, and virtual classroom formats.

- Track and report training completion, assessment scores, and post-training performance metrics (audit accuracy, QA results, appeals outcomes); use data to evaluate program effectiveness and drive continuous improvement.

- Identify training gaps through QA results, audit performance data, appeals trends, and direct observation; develop and execute targeted remediation plans.

- Conduct User Acceptance Testing on new audit platform workflows and reporting enhancements; incorporate findings into training materials before go-live.

- Deliver training on new client implementations, new audit programs, and updated audit concepts in coordination with operations and management.

Clinical Subject Matter Expertise

- Serve as the primary subject matter authority for IPF audit training, including: inpatient psychiatric medical necessity criteria (vs. PHP and IOP level of care), qualifying DSM-5 diagnoses, physician certification and attestation requirements, daily progress note standards, treatment plan documentation, safety and risk assessment requirements, and ECT add-on billing under IPF PPS.

- Serve as the primary subject matter authority for IRF audit training, including: the 60%/75% compliance rule and qualifying conditions, pre-admission screening, post-adm