UM Trainer (RN) - Hybrid

UPMC Health Plan is hiring a full-time Um Trainer to join the UM Clinical Operations team. This is a hybrid role requiring onsite presence at the U.S. Steel Tower in downtown Pittsburgh for at least a few days each month. Onsite requirements may increase over time based on business needs.

The ideal candidate holds an active RN license and a bachelor’s degree, has prior training experience, and brings a strong background in Utilization Management (UM). Experience with Epic or another electronic health record (EHR) system is a plus.

This role supports the Clinical Operations and Medical Management department through clinical training, onboarding, and quality assurance activities. This position collaborates with leadership, managers, supervisors, and external partners to ensure clinical and non-clinical staff maintain high-quality medical management skills.



Responsibilities:

• Partner with UM Operations and Medical Management leadership to design and execute auditing and education plans for Clinical Operations and Medical Management staff.
• Develop and deliver comprehensive, individualized orientation programs with one-on-one support throughout the orientation period along with educational plans for new and existing staff in Clinical Operations and Medical Management.
• Stakeholders include staff, physicians, department leadership, and third-party vendors. Uses specific age and culture-related physical, intellectual, psychological, and development attributes in the educational plans for staff.
• Provide ongoing education based on internal and external audit findings.
• Support adoption and continued use of the electronic medical record and related systems.
• Reports to either the VP, UM Operations, or Senior Director(s) of Medical Management and Clinical Operations with matrix reporting to other areas in Medical Management.
• Collaborate with internal educators and subject-matter experts to deliver targeted training.
• Conducts department-specific assessment to identify compliance-related for educational needs.
• Perform monthly auditing in high-risk areas and recommend staff education, process, or documentation improvements.
• Deliver annual InterQual criteria updates and conduct annual Interrater Reliability Assessment (IRR).
• Evaluate the effectiveness of all educational activities and adjust programs accordingly.
• Facilitate workshops and training sessions for clinical operations and medical management teams.
• Identify and communicate updates related payor requirements to targeted groups.
• Develop educational materials and resources for internal/external customers.
• Maintain and update educational content needed for staff orientation, day-to-day operations, and continuing education on SharePoint sites.
• Develop annual education plan to ensure Clinical Operations and Utilization Management staff receive current best-practice guidance and relevant updates.
• Conduct focused monthly audits for specific areas of focus as directed by leadership, to ensure adherence to clinical best practice.
• Create, implement, and evaluate an on-going medical management skills development program for all medical management and clinical operations staff.
• Establish team benchmarks and provide periodic reports to department leadership on medical management.
• Coordinate with other departments to ensure readiness for audits and support on follow-up audit recommendations.
• Assist with department project and program/process improvement efforts.

• Registered Nurse required.
  • Preference will be given to those with a PA license.
• Bachelors degree required
• 3 years experience in Care Management, or Utilization Management required.
• Utilization Management experience is highly preferred

• Education and/or training experience highly preferred
  

  
  
  
  
  Licensure, Certifications, and Clearances:
  

• Registered Nurse (RN)
• Act 34
• Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.