Ops-Um Training Specialist

Summary

Join Integra Partners' Operations Training & Development team as an Operations UM Training Specialist! This role requires a strong nursing background and expertise in utilization management (UM). You will design, develop, and implement training programs for UM clinical staff, ensuring compliance with healthcare regulations. Collaboration with leadership and the executive team is key to supporting business objectives and driving change. The ideal candidate is driven to learn, grow, and push professional boundaries. This position offers a competitive salary and a comprehensive benefits package.

Requirements

• Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) certification from an accredited nursing program required
• Current, active LPN/LVN license
• Minimum of 2 years of experience in clinical nursing, with at least 4 years in Utilization Management
• 2+ Years of experience in Training & Development, healthcare experience preferred in a training environment
• Knowledge and practical experience with Utilization Management within the healthcare industry, including pre-authorization and utilization reviews, along with medical claims processing
• Proven experience in designing multiple training events in a corporate setting
• Extensive knowledge of instructional design theory and learning principles
• Familiarity with traditional and modern training methods, tools, and techniques
• Adequate knowledge of learning management software
• Ability to execute and thrive in a fast paced, changing, matrixed and highly collaborative environment
• Must be able to manage large scale, complex projects for the company on time, within budget and with agreed upon deliverables
• Strong facilitation, communication, presentation and training skills
• Ability to lead and motivate others
• Ability to interact effectively across all levels of the organization
• Experience from consultation to development and implementation of initiatives
• Self-motivated, entrepreneurial attitude with a willingness to do whatever it takes to get things done

Responsibilities

• Work with the Manager of Operations Training to develop an end-to-end training roadmap and training calendar, as per business needs, in association with department leaders to deliver appropriate and effective training
• Develop and maintain the UM training curriculum for both administrative and clinical processes
• Develop and deliver comprehensive training programs for UM clinical staff on: Writing clear and concise clinical summaries
• Develop and deliver comprehensive training programs for UM clinical staff on: Applying medical necessity criteria effectively
• Develop and deliver comprehensive training programs for UM clinical staff on: Composing complex denial letters that meet regulatory standards
• Ensure all training materials and methods comply with healthcare regulations and are written at appropriate grade levels for clarity and accessibility
• Stay current with industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required
• Collaborate with leadership to identify training needs and develop strategies to improve overall UM processes
• Develop and maintain a working knowledge of all UM systems and processes, and create system manuals for admin and clinical training
• Ensure execution of training policy across a diverse workforce including diverse locations and skill sets. Elevate skill levels by effective coordination and presentation of training and development programs
• Assess training needs, define training requirements, and develop training plan which contains measurement of success to support Operations
• Design, develop and implement training content using different learning modalities for internal employees and external customers in partnership with internal subject matter experts
• Create different learner journeys based on job roles, competency levels and training needs
• Create content that addresses skill and knowledge gaps, need for improvement, or change in processes
• Own, evaluate, and constantly improve the New Hire Orientation. Collaborates with each of the operational areas to create content for Department specific New Hire Orientations
• Along with business partners, identify individual and team weakness and work with subject matter experts to create and deliver refresher training in partnership with Quality and department leaders
• Conduct training for new hires and refresher training across all levels of the operations areas
• Track training progress, monitor access, and consistently strive to improve effectiveness of training delivered to ensure incorporation of taught skills and techniques into employees work behavior
• Develops and implements effective ways to conduct training and make it fun through workshops, training retreats, gamification etc
• Support the development and implementation of change enablement strategies, processes, and methodologies, including change management and training. Provides guidance and support for all change enablement initiatives and/or corporate projects that contain aspects of change
• Optimize key business processes by providing product, technical and compliance knowledge training
• Oversees all lesson plans for each application by ensuring quality assurance checks are in place and that training captures both system and workflow process
• Partner closely with other Application Team leads and ensure training needs are met and executed efficiently
• Updates management and stakeholders during regular meetings on training program status and updates
• Stay abreast of the new trends and tools in employee learning and development
• Other training/development duties and activities assigned as needed

Preferred Qualifications

• Certification in Utilization Review or Case Management
• Experience with health insurance operations and claims processing
• Familiarity with quality improvement methodologies
• Experience using training tools such as Articulate or Captivate and learning management solutions preferred
• Experience using learning management software such as Eloomi preferred
• Understanding of career development and employee engagement practices and experience measuring engagement and implementing practices to increase organizational performance
• Demonstrated enthusiasm about the growth and development of people to reach their full potential through skill building experiences
• Experience training for call center or Operations areas in the health care industry preferred

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities
• Remote Opportunities