Utilization Management Clinical Trainer (Hybrid Remote)

Benefits

Additional Information

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Utilization Management Clinical Trainer plays a vital role in onboarding and developing clinical staff to ensure high-quality, consistent, and compliant utilization review services. This position is responsible for designing and delivering training programs for new utilization review nurses and coordinators, as well as providing ongoing education and support to current team members. The Utilization Management Clinical Trainer also collaborates with other clinical trainers to create standardized training materials that support clinical consistency across roles at Alignment. In addition to leading training initiatives, the Utilization Management Clinical Trainer contributes to utilization review audits and interrater reliability (IRR) assessments to promote ac-curacy, quality, and alignment with internal policies, accreditation standards, and regulatory guidelines. This position enhances reviewer confidence, ensures peer alignment, and encourages a culture of continuous learning, which are essential elements in developing a high-performing clinical team. This position builds and maintains strong collaborative partnerships with key partners in the Clinical Services organization including Care Management, Performance Improvement, Medical Management and Policy including Quality and Medical Review and Appeals, Pharmacy, and Provider Integration to identify, develop, implement, and monitor performance metrics related to UM Operations. This position also builds strong collaborative partnerships internally and externally with key stakeholders and vendors to ensure that internal and external UM operations programs are well-coordinated and work cooperatively to achieve outcomes goals. Areas of direct responsibility include Medical Utilization Management including Inpatient Review & Prior Authorization, SNF concurrent review, and pre-service authorization process. This position is primarily remote; however, in-person attendance at Alignment Health's headquarters in Orange, CA is required approximately once per quarter for leadership meetings and team collaboration. Candidates located outside of California should expect periodic travel to the Orange office. Travel expenses are reimbursed in accordance with company policy. Job Duties/Responsibilities: Training and Onboarding 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 Design and deliver training for new processes, tools or platforms to ensure confident adoption and effective daily use Adapts training to reflect evolving regulatory environments, including state-specific utilization review requirements and client-specific clinical policies Audit & Interrater Reliability (IRR) 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 Assists the compliance officer with tracking and reporting on training completion, clinical quality improvements, and IRR improvements over time Support leadership in maintaining compliance with compliance standards and other applicable guidelines Team Support & Collaboration 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 te