UM Program Integrity Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee the creation, execution, maintenance, and ongoing enhancement of a thorough UM Training Plan tailored for administrative and clinical support roles.

• Perform training needs assessments in collaboration with UM leadership, the Clinical Education Team, subject matter experts, and operational stakeholders.

• Design role-specific learning pathways, onboarding curricula, competency-based education, refresher training, and training plans related to workflows.

• Develop, revise, and organize training materials, job aids, desk references, learning resources, and educational content.

• Assist in adapting training content for Alliance University and other sanctioned learning platforms.

• Evaluate training effectiveness through feedback, completion statistics, audit findings, competency trends, and input from leadership.

• Coordinate training priorities linked to onboarding, role transitions, changes in workflows, policy updates, system modifications, regulatory requirements, and performance or process deficiencies.

• Lead or assist in the delivery of UM training alongside operational leaders, the Clinical Education Team, and subject matter experts.

• Maintain UM policies, procedures, desk procedures, program descriptions, program evaluations, job aids, and associated resources.

• Analyze workflows, pinpoint process deficiencies, and propose enhancements to ensure consistency, role clarity, and operational efficiency.

• Facilitate MCG integration activities and annual upgrades, which include aligning workflows, conducting testing, updating documentation, planning communication, and educating staff.

• Conduct or assist with audits and monitoring relevant to UM documentation, adherence to processes, training effectiveness, competency metrics, and quality trends.

• Present training, audit, and workflow results to leadership and suggest improvements.

• Aid in NCQA accreditation readiness, delegation oversight, audit follow-ups, and ensuring regulatory compliance.

⛳️ Requirements

• A bachelor's degree in education, instructional design, training and development, organizational development, healthcare administration, public health, behavioral health, human services, nursing, social work, psychology, counseling, or a related field in healthcare, human services, or education is required.

• A minimum of five (5) years of experience in developing, implementing, maintaining, or evaluating training programs, learning plans, onboarding curricula, competency-based education, staff development initiatives, or role-specific learning pathways is required.

• Experience in conducting training needs assessments, developing curricula, designing training materials, collaborating with stakeholders, facilitating, or supporting learning platforms, and assessing training effectiveness.

• Proficient in using virtual training tools, digital learning platforms, Microsoft Office, and learning management systems or similar training platforms.

• Advanced understanding of training program development, curriculum design, onboarding support, competency-based education, and principles of adult learning.

• Capable of creating and sustaining role-based learning pathways, training plans, job aids, desk references, and learning resources.

• Excellent written communication skills for converting complex workflows, policies, procedures, and regulatory requirements into clear training materials.

• Strong verbal communication, facilitation, collaboration, and stakeholder engagement abilities.

• Exceptional organizational, project coordination, prioritization, and follow-through capabilities.

• Strong analytical, evaluation, and critical thinking skills.

• Familiarity with utilization management operations, managed care, Medicaid, healthcare authorization workflows, and clinical or administrative UM documentation.

• Knowledge of NCQA accreditation standards, delegation oversight, audit readiness, quality monitoring, and regulatory requirements.

• Experience in supporting the development of policies, procedures, workflows, program descriptions, program evaluations, or operational documentation.

• Experience in facilitating process improvement, workflow standardization, monitoring tools, audit templates, or corrective action support.

• The selected candidate must reside in North Carolina.

• Clinical licensure is not a requirement for this position.

🏝️ Benefits

• Medical, Dental, Vision, Life, Long-Term Disability Insurance.

• A generous retirement savings plan.

• Flexible work schedules, including hybrid and remote options.

• Paid time off that includes vacation, sick leave, holidays, and management leave.

• Dress code flexibility.