Utilization Management (UM) Trainer at OncoHealth — Remote, USA | Base Career

Full Job Posting

• Oversee Training Design & Delivery

Create consolidated training materials and framework for onboarding of CRS (Case Review Specialist) roles
Ensure that training materials are customized to address key operational and system variances such as UM Applications, Mainland v Puerto Rico, and Phone vs Non-Phone Roles
Plan training agendas and approach to include virtual delivery, validation of learning, and schedules and materials
Support continuous improvement of training plans and materials based on feedback from new hires and long-term success (measured by metrics including quality, productivity and retention)
Work with operations and HR to schedule training sessions for new hires
Ensure new hire capacity is appropriately planned to align with prioritized operational needs
Develop “retraining” and “advanced training” materials for existing employees over time to support change management, quality improvement, and upskilling

• Performance Monitoring & Continuous Improvement

Measure training effectiveness through assessments, quality outcomes, learner feedback, and operational performance metrics.
Analyze training results and identify opportunities for curriculum improvements.
Track training completion and maintain training records.
Recommend innovative learning solutions and process improvements.

• Quality & Compliance Education

Partner with Quality and Compliance teams to identify training opportunities based on audit findings, trends, and performance metrics.
Ensure training content aligns with NCQA, URAC, CMS, HIPAA, and client requirements.
Reinforce compliance expectations and documentation standards across all UM functions.
Provide remediation training when performance gaps are identified.

Collaborate with Operations, Quality, Clinical, Customer Support, Product, and Compliance teams to ensure training remains aligned with business needs.
Collaborate with HR to align employee start dates with training schedules and team capacity needs and priorities for onboarding
Collaborate with HR and UM quality leadership to understand employee feedback during coaching and exit interviews that may lead to insights and continuous improvement for training materials and processes
Participate in cross-functional initiatives and process improvement projects.
Serve as a subject matter resource for UM workflows, systems, and best practices
Associate or bachelor’s degree preferred, particularly in: Healthcare Administration, Health Information Management, Business Administration or a related field. Relevant experience may be considered in lieu of a degree.
Typical years of experience are a minimum of 3–5 years in healthcare operations, utilization management, prior authorization, or related healthcare experience.
Minimum of 1–2 years of training, coaching, mentoring, quality, or leadership experience preferred.
Experience creating training materials and facilitating adult learning programs preferred.
Strong presentation and facilitation skills.
Excellent verbal and written communication skills.
Strong organizational and project management abilities.
Ability to explain complex concepts in a clear and engaging manner.
Strong analytical and problem-solving skills.
Ability to coach and develop employees through various learning styles.
High attention to detail and commitment to accuracy.
Ability to manage competing priorities and drive results through others.
Systems/Tools: MS Office Suite proficient.

with call center platforms, case management systems, and workforce management tools preferred.

Ability to remain seated for extended periods while working at a computer workstation and managing a high volume of inbound phone calls.
Workspace must be PHI‑compliant, ensuring privacy and always safeguarding protected health information. This includes: A private environment where conversations cannot be overheard Secure handling of all electronic and written information Compliance with HIPAA and company privacy standards
A private environment where conversations cannot be overheard
Secure handling of all electronic and written information
Compliance with HIPAA and company privacy standards
Reliable internet connectivity, power supply, and equipment capable of supporting sustained call volume and system usage.
Ability to maintain focus and productivity in a fast‑paced, high‑volume operational environment.

Utilization Management (UM) Trainer

Job Fit Check

Full Job Posting

• Oversee Training Design & Delivery

• Performance Monitoring & Continuous Improvement

• Quality & Compliance Education

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