Utilization Management Educator (REMOTE)

TurningPoint Healthcare Solutions•Lake Mary, FL

23h•Remote

About The Position

Utilization Management Educator Who We Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system. Position Summary: The Utilization Management (UM) Educator is responsible for the design, development, delivery, and evaluation of clinical and operational training programs that support utilization management functions across the organization. This role provides hands-on and virtual training to UM staff and partners, ensuring competency in regulatory requirements, clinical review processes, payer guidelines, and organizational policies. The UM Educator collaborates with internal stakeholders to ensure training content remains current, compliant, and aligned with evolving regulatory, accreditation, and reimbursement standards across commercial and government programs. The UM Educator plays a critical role in supporting quality, compliance, and operational efficiency by standardizing education, improving staff performance, and promoting best practices within the UM program.

Requirements

Bachelor’s degree in nursing (BSN) required; Master’s or Doctorate degree preferred.
Active, unrestricted Registered Nurse (RN) license.
Minimum of five (5) years of experience in Utilization Management, Managed Care, or a related healthcare environment.
Demonstrated experience in clinical education, staff development, or training delivery.
Strong understanding of utilization management principles, clinical review processes, and payer requirements.
Excellent verbal and written communication skills with the ability to present complex information clearly and effectively.
Proven ability to build relationships and collaborate with multidisciplinary teams, including physicians, hospital leadership, medical groups, and health plan staff.
Strong organizational, analytical, and problem-solving skills.
Ability to lead, influence, and motivate staff while fostering a positive and productive learning environment.
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook); experience with learning management systems (LMS) preferred.
Commitment to customer service, continuous improvement, and excellence.

Nice To Haves

Experience with adult learning principles, instructional design, and performance improvement.
Prior experience supporting regulatory compliance and quality initiatives.
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook); experience with learning management systems (LMS) preferred.

Responsibilities

Training Delivery and Facilitation Facilitate engaging in-person, virtual, and hybrid clinical and operational training sessions for new hires and existing staff.
Support and participate in new hire orientation and onboarding for UM-related roles.
Provide ongoing education to support changes in regulations, payer requirements, workflows, and systems.
Curriculum and Content Development Design, develop, and maintain comprehensive training curricula, materials, and learning resources in collaboration with subject matter experts (SMEs).
Create a variety of instructional materials, including training manuals, job aids, presentations, e-learning modules, system demonstrations, and reference tools.
Translate complex regulatory, clinical, functional, and technical requirements into clear, user-friendly learning content.
Review standard operating procedures (SOPs), workflows, and system functionality to ensure training content is accurate and current.
Needs Assessment and Program Evaluation Assess training needs through data analysis, stakeholder input, performance metrics, and review of training and development records.
Identify skill gaps and prioritize training initiatives to support annual business goals and performance targets.
Evaluate training effectiveness using qualitative and quantitative methods and communicate findings and recommendations to leadership.
Collaboration and Stakeholder Engagement Partner with business leaders, clinical staff, preceptors, IT, technical writers, and project teams to align training with operational and system changes.
Gather and synthesize structured and unstructured information from stakeholders to inform training design.
Network with internal and external stakeholders to ensure training reflects current industry standards and best practices.
Regulatory and Compliance Support Maintain working knowledge of regulatory and accreditation standards, including Medicare, Medicaid, and commercial payer requirements.
Support compliance, quality management, and audit readiness initiatives through education and standardized training.
Develop and refine UM training processes to promote consistency, efficiency, and regulatory compliance.
Additional Responsibilities: Research, evaluate, and recommend external training programs or professional development opportunities as appropriate.
Demonstrate professionalism and effective verbal, written, and non-verbal communication at all organizational levels.
Travel as required to support training and organizational needs.
Perform other duties as assigned.