CareFirst Careers

Case Management Training & Quality Improvement Specialist

Resp & Qualifications

PURPOSE: Proactively and in collaboration with the management team, develops training standards, policies and procedures, and formal job aids to ensure high quality of Case Management activities provided by CareFirst BCBS. Delivers formal and informal training to include, but not limited to webinars, classroom setting, individual and group sessions. Coordinates and completes the training/educational activities of the newly hired and existing Case Managers and assists with design and development of educational programs.  Conducts training needs assessments to provide continuous development of Case Managers’ clinical and administrative skills. Performs quality audits by reviewing designated staff queues, random sampling of case documentation and case processing for each Case Manager. Facilitates continued education credits and re-training sessions as requested.  In conjunction with the management team, helps create a motivated, skilled and effective, efficient Case Management team through which organizational goals are achieved.

Under the general direction of the management team in the Case Management department, the incumbent’s accountabilities include but are not limited to, the following:


  1. Uses instructional design and adult learning principles to develop and deliver timely and effective clinical  and technical, job skills  and motivational interviewing training programs for Case Management associates in a constantly changing environment, utilizing industry standard training tools, methods, and approaches. This would involve training of new associates and training and education of existing associates. The incumbent will also assist with design and development of educational programs. These programs will provide trainees with the appropriate breadth and depth of understanding of a variety of CareFirstBCBS programs, products, and systems, including -- but not limited to – the alignment and integration of Case Management with Total Care and Cost Improvement (TCCI), Hospital Transition of Care (HTC) and Patient Centered Medical Homes (PCMH) programs, as well as product lines such as Indemnity, FEP, HMO, etc.  Projects a positive and enthusiastic attitude towards Case Management assignments and Medical Affairs divisional goals.  Ensures that all training benchmarks of s of productivity and quality can be attained by the by the new associate.  Conducts needs assessment, retraining and cross-training as necessary to ensure associate skill base is current and meets case management standards.  Develops and implements individualized training plans for all new associates and assists in planning and coaching with those that have identified learning needs. Acts as a mentor, providing feedback and coaching as the trainees apply the classroom content to real-world job duties.
  2. Creates, updates and modifies training manuals, materials, job aides and course content, Case Management processes and programs to reflect new and revised standard operating procedures, products, systems, regulations, as needed to provide up-to-date and accurate training in order to meet Case Management standards.
  3. Performs quality audits by reviewing designated staff queues, random sampling of case documentation and case processing for each case manager. Provides feedback to management team regarding performance, and assist in  development of  specific action plans when remedial training is necessary in order to ensure that Case Management  standards and NCQA/MIA guidelines are met and improved member clinical outcomes are achieved.
  4. Completes projects as requested by management team related to nurse training and support of Case Management Department.  Perform administrative tasks, as necessary, to ensure appropriate scheduling of training activity, etc.  Performs case management activities as requested by Manager/ Supervisor when coverage issues exist as reported by Case Management Supervisors.

Minimum Qualifications: Required Experience/Skills/Abilities: 
• Bachelor’s degree in Nursing or equivalent related experience
• Five years prior clinical experience, three years of managed care experience, and an active RN license.
• Additionally 1-3 years of experience in instructional design, curriculum development and implementation, and program evaluation in a formal training environment. 
• Must be familiar with the managed care environment, case management, and home healthcare and community base resources. 
Certification in Case Management is preferred at time of hire. Incumbents not previously certified will be required to achieve certification in case management within the next testing cycle for a certification that is a recognized board certification in case management.   
• Thorough knowledge and expertise in case managing complex cases with minimal supervision. 
• Superior verbal and written communication, presentation, interpersonal, time management, planning and organizational skills. Ability to effect change, and perform critical analysis.  
• Demonstrated proficiency with current technology to research information.  Must have the ability to talk on the phone and type. 
• Strong computer skills and advanced ability in Microsoft Office Suite: Word, Power Point, Excel, Access. 
• Ability to present training to small and large groups, and to effectively express ideas and information in writing. 
• Proven ability to provide mentoring, coaching and feedback for improvement (both verbally and in writing) to new and seasoned members of the team.
• Ability to prioritize concurrent projects so that timeframes are met. 

• Master’s Degree in Education, Nursing, or related field.
• Formal training in instructional design and adult learning principles.
• Must possess extensive knowledge of care coordination guidelines and systems.   Knowledge of programs, benefits, policies, and procedures for CareFirstBCBS, HMO, FEP, and ICentric knowledge. 
• Thorough knowledge of CareFirstBCBS and Divisional goals and procedures related to professional provider relations. 
• Complete knowledge of all computer systems: NASCO, Facets, Client Letter, iCentric, Lync.

Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  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.



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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 09/12/2019

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.

No restrictions.  Majority of day sitting with heavy use of PC and telephone.

The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.

The employee 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 employee must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Medical Management