Utilization Management Um Nurse Jobs (NOW HIRING)

OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.

The UM Trainer is responsible for designing, coordinating, and delivering training programs that support the onboarding, development, and ongoing education of Utilization Management team members. This role ensures employees are equipped with the knowledge, skills, and resources needed to perform their responsibilities accurately, efficiently, and in compliance with regulatory, client, and organizational requirements. The UM Trainer partners with operations, quality, compliance, and leadership teams to identify training needs, develop learning solutions, and promote continuous learning and performance improvement.

Primary Responsibilities:

• 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.
• Collaboration & Stakeholder Partnership
• 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

About You:

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

Remote Work Requirements:

• 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
• 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.

About the Location:

OncoHealth is committed to remote, hybrid or in office work options. The majority of the team will be remote or in hybrid work arrangements with offices in Atlanta, GA and Guaynabo, PR. We are open to employees nationwide but work primarily in the Eastern and Central Time Zones.

Our Culture:

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first! We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!

OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity:

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions:

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment. OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape. OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff. OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.