UM Program Integrity Specialist

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $69.6k - $90.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Alliance Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Alliance Health is a regional health plan serving residents of several North Carolina counties by administering Medicaid and state-funded behavioral health and specialty services. It operates Tailored Plan coverage and Medicaid Direct options that integrate physical health, pharmacy, behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, provides 24/7 behavioral health crisis support, member and provider portals, community trainings and outreach, and coordinates care through provider networks and governance committees.

📋 Description

• Lead the development, implementation, maintenance, and continuous improvement of a comprehensive UM Training Plan for administrative and clinical support roles • Conduct training needs assessments with UM leadership, the Clinical Education Team, subject matter experts, and operational stakeholders • Develop role-based learning pathways, onboarding curricula, competency-based education, refresher training, and workflow-related training plans • Create, update, and organize training materials, job aids, desk references, learning resources, and educational content • Support conversion of training content for Alliance University and other approved learning platforms • Monitor training effectiveness using feedback, completion data, audit findings, competency trends, and leadership input • Coordinate training priorities related to onboarding, role transitions, workflow changes, policy updates, system changes, regulatory requirements, and performance or process gaps • Facilitate or support UM training delivery with operational leaders, the Clinical Education Team, and subject matter experts • Maintain UM policies, procedures, desk procedures, program descriptions, program evaluations, job aids, and related resources • Evaluate workflows, identify process gaps, and recommend improvements supporting consistency, role clarity, and operational efficiency • Support MCG integration activities and annual upgrades, including workflow alignment, testing, documentation updates, communication planning, and staff education • Conduct or support audits and monitoring related to UM documentation, process adherence, training effectiveness, competency indicators, and quality trends • Report training, audit, and workflow outcomes to leadership and recommend improvements • Support NCQA accreditation readiness, delegation oversight, audit follow-up, and regulatory alignment

🎯 Requirements

• Required 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 healthcare, human services, or education field • Required five (5) years of experience developing, implementing, maintaining, or evaluating training programs, learning plans, onboarding curricula, competency-based education, staff development initiatives, or role-based learning pathways • Experience with training needs assessment, curriculum development, training material design, stakeholder collaboration, facilitation or learning platform support, and evaluation of training effectiveness • Proficiency using virtual training tools, digital learning platforms, Microsoft Office, and learning management systems or comparable training platforms • Advanced knowledge of training program development, curriculum design, onboarding support, competency-based education, and adult learning principles • Ability to develop and maintain role-based learning pathways, training plans, job aids, desk references, and learning resources • Strong written communication skills for translating complex workflows, policies, procedures, and regulatory expectations into clear training materials • Strong verbal communication, facilitation, collaboration, and stakeholder engagement skills • Strong organizational, project coordination, prioritization, and follow-through skills • Strong analytical, evaluation, and critical thinking skills • Knowledge of 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 supporting policy, procedure, workflow, program description, program evaluation, or operational documentation development • Experience supporting process improvement, workflow standardization, monitoring tools, audit templates, or corrective action support • Selected candidate must reside in North Carolina • Clinical licensure is not required for this position

🏖️ Benefits

• Medical, Dental, Vision, Life, Long Term Disability • Generous retirement savings plan • Flexible work schedules including hybrid/remote options • Paid time off including vacation, sick leave, holiday, management leave • Dress flexibility