After 1991, Pietramala took jobs as an assistant coach at
Gilman School,
Johns Hopkins University, the
University of Pennsylvania, and
Loyola College before returning to Johns Hopkins as its defensive coordinator in 1995. In 1998 he took over the head coaching job at
Cornell University, where he was named the national
Coach of the Year in 2000. In April 2020, after the 2020 season was cut short by the
COVID-19 pandemic, Johns Hopkins announced that they had mutually agreed to part with Pietramala, ending his tenure as the head coach. Pietramala joined the coaching staff of
Boys' Latin School of Maryland in the spring of 2021, assisting on the defensive side of the ball and coaching his two sons, Dominic and Nicholas. An up and down regular season gave way to a hot playoff streak that saw the sixth-seeded Lakers win the MIAA A Conference championship, defeating
Archbishop Spalding in the finals. On Monday, June 14, 2021, it was announced that Pietramala would be joining the
Syracuse University coaching staff, led by
Gary Gait, as their defensive coordinator for the spring 2022 season. The unification of this tandem gave the Syracuse coaching staff, arguably, the best offensive and defensive players in the history of the sport. He inherited a defense that was one of worst at Syracuse and struggled to dramatically improve the squad. During his short tenure, the Orange defense could stop opponent's best option but allowed secondary scorers to thrive. After two seasons working with Gait at Syracuse, Pietramala left for UNC to join Joe Breschi's staff. ==Head coaching record==