Ops-UM Training Specialist

Integra Partners is seeking an experienced nurse educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have a strong nursing background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance, and will be responsible for the design, development, implementation, coordination, and facilitation of the Operations training and development program. The Operations UM Training Specialist will work in collaboration with Operations leadership and the executive team to support key business and people objectives. They will work on business-specific strategic imperatives that focus on assessing and diagnosing organizational needs, driving change, and delivering best-in-class training solutions to support the business strategy. The right candidate will be driven by the opportunity to learn, grow and push their professional boundaries.
Salary: $70,000.00/Annually
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
Training Specialists’ responsibilities include but are not limited to:

• Works 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
  • Applying medical necessity criteria effectively
  • 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.
• Ensures 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.
• Assesses training needs, defines training requirements, and develops 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.
• Creates 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.
• Owns, evaluates, and constantly improves 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.
• Conducts 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. Optimizes 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.

WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS:

• Integra Partner’s business model and its role in providing health care services to our customers.
• In-depth understanding of Integra Partner’s business processes and technical systems that support our core operations.
• Working knowledge of Eloomi, Integra Partner’s new learning management tool.
• Understanding and alignment of the training department’s strategic and tactical goals with organizational and business priorities.

WHAT WILL YOU ACCOMPLISH IN THE FIRST 12 MONTHS:

• Develop and implement new hire and refresher training programs for UM staff and other select operational areas.
• Implement and maintain Integra’s new learning management software.
• Develop best-in-class learning content based on different learner personas.
• Implement and track learning metrics to measure the effectiveness of the training program.
• Develop key processes to use feedback from training assessments, the quality assurance team and leaders to design individual training plans to help improve employee performance

EDUCATION:

• Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) certification from an accredited nursing program required
• Current, active LPN/LVN license

EXPERIENCE:

• 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.
• Experience training for call center or Operations areas in the health care industry preferred.
• Adequate knowledge of learning management software. 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.
• 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.

PREFERRED SKILLS:

• Certification in Utilization Review or Case Management
• Experience with health insurance operations and claims processing
• Familiarity with quality improvement methodologies