Training & Quality Specialist - RN (Hybrid)

Resp & Qualifications PURPOSE: We are looking for an RN with significant clinical educator experience to work in a hybrid role from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, trainings, provide training support for Care Management employees and/or other business-related activities. This role provides relevant new hire and supportive ongoing training/professional development which create and maintain a motivated, skilled and effective team through which organizational goals are achieved. In this position, the incumbent will be supporting all market segments of the Care Management Department providing training for Care Management employees related to new technology and documentation with our Guiding Care platform, the Care Management process, and interventions to drive outcomes for our members. Demonstrated experience with Electronic Medical Records platforms (EMR) with a proven ability to act as a liaison between Care Management Operations and IT/technology teams. The ideal candidate will have strong understanding of how technology supports population health, care coordination, and compliance initiatives. Experience coordinating system enhancements, workflow optimization, and care management documentation processes within an EMR environment. ESSENTIAL FUNCTIONS: Designs, develops and/or facilitates instructor led training and development programs. Consistently delivers a quality program in the formal didactic, virtual or informal setting using adult learning principles. Uses instructional design principles to scope, review, modify, and redesign training materials to reflect current research and best practices and align with culture, core principles and strategic goals. Represents Care Management Operations and partners with the Guiding Care Product teams/IT to coordinate system enhancements, workflow optimization, and care management documentation processes within and EMR environment to maintain compliance and accreditation. Assesses learning needs, designs, develops, organizes, implements, and evaluates educational programs (orientations, continuing education, and in-services) that facilitate the professional growth, knowledge and skill development, competency, applicable regulatory standards, and attainment of standards of care for care managers or other clinical and non-clinical team members. Organizes and supports the educational activities of the team, which includes regular or adhoc educational sessions, webinars, learning tools, assisting with departmental development-related meetings, and providing other support. Provide Quality reviews for Care Management employees related to the Care Management process, NCQA documentation and interventions to drive outcomes for our members. Identifies educational opportunities in support of influencing stakeholder behavior and bending cost trends. Acts as a mentor, providing feedback and coaching as new and experienced team members apply the didactic content to real-world job duties. Provides supportive oversight following the initial orientation period to ensure thorough understanding and incorporate all information presented during the training/orientation program and are prepared to successfully launch into performing core job duties. Reviews accuracy and effectiveness of curriculum and content, providing timely and constructive feedback to employees and people leaders on their performance during training for development and learning opportunities. Collaborates with colleagues and people leaders to identify best practices so that those practices can be shared in an efficient and expeditious manner to improve care delivery, member experience or other critical business deliverables. Reviews randomized selected care plans and/or case reviews to assess quality and appropriateness. Delivers feedback to people leaders on quality trends. QUALIFICATIONS:Education Level: Bachelor's Degree in Nursing, Healthcare Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Licenses/Certifications Upon Hire Required: RN - Registered Nurse - State Licensure And/or Compact State Licensure. Experience: 8 years clinical experience in a healthcare setting with 2 years of demonstrating increasing responsibility for training, precepting and/or mentoring staff in relevant healthcare field. Working knowledge of instructional design and/or curriculum development, and experience with implementation and program evaluation from a training and quality improvement perspective. Preferred Qualifications: Strong understanding of how technology supports population health, care coordination, and compliance initiatives. Experience coordinating system enhancements, workflow optimization, and care management documentation processes within an EMR environment. Master's degree in Nursing and/or Instructional Design. Knowledge, Skills and Abilities (KSAs) Excellent presentation skills, superior meeting facilitation skills, the ability to influence others, superior written and oral communication skills, including the ability to successfully interact with all levels of associates. Ability to train, mentor and give constructive feedback in group and individual settings. Strong interpersonal skills and the ability to work with clinical and non-clinical staff. Ability to facilitate meetings in an efficient and effective manner. Experience with computer programs such as Microsoft Word, Excel, Access, PowerPoint and Outlook. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Salary Range: $77,256 - $153,439 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Care Management Training Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-SS1

Created: 2026-03-06