Utilization Management Clinical Trainer (Hybrid Remote)

Job Duties/Responsibilities

• Develop and implement onboarding and training programs for new staff in the utilization review process
• Create and maintain utilization review clinical training materials, quick-reference guides, and job aids that reflect up-to-date policies, processes, and review criteria to reflect changes in workflows, tools, and compliance requirements
• Design utilization review and other clinical training content to support standardized workflows used by all clinical reviewers, ensuring clarity and consistency across the clinical teams
• Collaborate with all trainers (clinical and non-clinical) to ensure consistency in approach and style across the organization
• Deliver engaging, practical education using real-world examples and case studies
• Adapt training to reflect evolving regulatory environments, including state-specific utilization review requirements and client-specific clinical policies
• Participate in routine and targeted audits of medical necessity reviews to ensure quality, compliance, and appropriate clinical decision-making
• Collaborate with the Compliance Officer to conduct interrater reliability assessments to ensure consistency among reviewers
• Identify trends, gaps, or performance issues through audit and IRR results, and develop targeted training to address findings
• Aids the compliance officer with tracking and reporting on training completion, clinical quality improvements, and IRR improvements over time
• Supports the leadership in maintaining compliance with compliance standards and other applicable guidelines
• Serve as a resource for clinical staff, offering guidance on accessing and interpreting clinical protocols, documentation practices, and decision-making frameworks
• Collaborate with clinical leadership to identify training needs and support operational goals
• Ensure consistency in training documentation across all clinical teams, including those supporting physician review
• Promote a positive, engaged team culture that reflects ICM’s values of kindness, personal responsibility, humble confidence, and a can-do attitude
• Contributes to clinical team engagement by supporting professional development, building confidence in decision-making, and promoting a shared understanding of clinical expectations

Job Requirements

• Minimum of 5 years nursing experience in managed care, utilization review, case management, quality improvement, or acute care nursing—particularly roles involving interdisciplinary coordination, clinical documentation review, or patient discharge planning
• Experience developing and delivering clinical training preferred; candidates without formal training experience may still be considered if they demonstrate strong clinical communication skills and a passion for developing others
• Comfort with technology platforms used for clinical documentation, utilization review, and virtual training delivery
• Bachelor’s degree in Nursing, Health or Education related field
• Licensure: Active and unrestricted Registered Nurse (RN) or Licensed Practical/Vocational Nurse (LPN/LVN) license in good standing in the United States

Essential Physical Functions

• Regularly required to talk or hear
• Regularly required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls
• Frequently lift and/or move up to 10 pounds
• Specific vision abilities required by this job include close vision and the ability to adjust focus

Pay Range

$77,905.00 - $116,858.00