Utilization Review Nurse Trainer

Innovative Care Management, Inc.; Oregon (IL); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare management organization is looking for a Utilization Review Nurse Trainer. This remote role involves developing training programs for nurses, conducting audits, and collaborating with clinical teams to enhance decision-making and continuous improvement. Ideal candidates will have extensive nursing experience and demonstrate strong communication and training skills.

Benefits

Flexible remote working options

Opportunities for professional development

Collaborative team culture

Qualifications

• Minimum of 5 years nursing experience in managed care, utilization review, or quality improvement.
• Strong clinical communication skills.
• Experience developing and delivering clinical training preferred.

Responsibilities

• Develop and implement onboarding for new clinical staff.
• Conduct audits and ensure compliance with standards.
• Serve as a resource for clinical staff.

Skills

Critical Thinking

Communication

Attention to Detail

Education

Bachelor's degree in Nursing

Job description

Description

Position Summary:

The Utilization Review Nurse 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, as well as providing ongoing education and support to current team members. The Utilization Review Nurse Trainer also collaborates with other clinical trainers to create standardized training materials that support clinical consistency across roles at ICM. In addition to leading training initiatives, the Utilization Review Nurse Trainer contributes to utilization review audits and interrater reliability (IRR) assessments to promote accuracy, 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 is a remote position; however, occasional in-office attendance may be required to deliver in-house training at our Portland, Oregon office. We are only considering candidates who reside in Oregon or Washington State.

Specific Position Requirements & Responsibilities:

Training and Onboarding:

• Develop and implement onboarding and training programs for new clinical 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 URAC 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 teams, including those supporting physician and chiropractic review.
• Promote a positive, engaged team culture that reflects ICM’s values of kindness, personal responsibility, humble confidence, and a can-do attitude.
• Contributes to clinical team engagement by supporting professional development, building confidence in decision-making, and promoting a shared understanding of clinical expectations.
• Other duties as assigned.

Requirements

Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:

Required:

• Minimum of 5 years nursing experience in managed care, utilization review, case management, quality improvement, or acute care nursing—particularly roles involving interdisciplinary coordination, clinical documentation review, or patient discharge planning.
• Experience developing and delivering clinical training preferred; candidates without formal training experience may still be considered if they demonstrate strong clinical communication skills and a passion for developing others.”
• Comfort with technology platforms used for clinical documentation, utilization review, and virtual training delivery.
• Key competencies this position will require:
  • Excellent verbal, written, and presentation skills.
  • Strong critical thinking and clinical judgment.
  • Detail-oriented, organized, and proactive.
  • Collaborative and approachable, with a passion for developing others.
  • Aligned with ICM’s culture of excellence, empathy, and continuous improvement.

Preferred:

• Experience working with self-funded ERISA health plans.
• Prior involvement in quality improvement, audits, or training development.
• Education or formal training in adult learning, instructional design, or staff development OR equivalent experience creating training materials in a clinical or healthcare setting.
• Strong understanding of medical necessity criteria, prior authorization processes, and relevant regulatory standards
• Familiarity with URAC requirements and utilization management best practices.

Education, Licensure, and Certification Requirements:

Required:

• Bachelor’s degree in Nursing, Health or Education related field .
• Active and unrestricted Registered Nurse (RN) license in good standing

Preferred:

• Additional certification in, healthcare management, or utilization review or case management (e.g., CCM, CPHM, CPUR).

Work and Physical Conditions:

This is a remote role requiring a quiet, secure workspace with reliable internet. Occasional in-person attendance (1–2 times per quarter) may be needed for collaboration or training. The position involves long periods of computer work, frequent communication, and light physical activity (up to 15 lbs). All work must comply with HIPAA standards, and reasonable accommodations are available for individuals with disabilities to perform the essential functions of this job.