CareFirst Careers

PCMH Training & Quality Specialist RN

Resp & Qualifications

The PCMH Training & Quality Specialist role exists to collaborate with PCMH Management and Senior Leadership in order to provide relevant new hire and supportive ongoing training/professional development which will help create a motivated, skilled and effective PCMH field team through which organizational goals are achieved.

The Training & Quality Improvement Specialist is responsible for driving positive outcomes through the delivery of effective training and development of PCMH team members as well as targeted quality improvement initiatives. The incumbent is part of a team which facilitates, coordinates, and monitors performance improvement initiatives for the PCMH program which is focused on lowering overall health care costs and improving health outcomes.

Under the general supervision of the Manager, PCMH Training & Quality Improvement, the incumbent’s accountabilities may include, but are not limited to, the following:

1. Designs, develops and/or facilitates instructor led training and development programs for Local Care Coordinators (primary) and for Regional Care Directors and PCMH Program Consultant audiences (secondary) that span a wide range of content areas.  Consistently delivers a quality program in the classroom 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 PCMH culture, core principles and strategic goals. 
• 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 coordinators in the community setting.
• The Training & Quality Specialist will be responsible for organizing and supporting the educational activities of the PCMH team, which includes monthly educational webinars and programs, learning tools, assisting with regional meetings, and providing regional support.
• Provides professional delivery of training programs to the Care Coordination team on the program structure and processes, iCentric functionality and use, development and evaluation of care plans, case load management, care coordination, Customer Service as well as CareFirst and community resources for improved clinical outcomes. 
• Works with Program Consultants to identify educational opportunities in support of influencing provider behavior and bending cost trends.
• Designs/redesigns materials to ensure the content is timely and reflects current operations. Regularly participates in corporate initiatives to proactively determine training needs and create initial documentation/materials.

2. Acts as a mentor, providing feedback and coaching as the trainees apply the classroom content to real-world job duties.
• Provides supportive oversight following the initial orientation period to ensure new LCCs thoroughly understand and incorporate all information presented during the training/orientation program, and are prepared to successfully launch into field activities.
• Reviews accuracy and effectiveness of PCMH Training curriculum and content, providing timely and constructive feedback to associates on their performance during training for development and learning opportunities.
• Identifies associate or team learning opportunity trends and coordinates development and execution of development plans or team reinforcement training.
• Attends team meetings occasionally to provide quick refresher training.

3. Leads and/or contributes towards Quality Improvement activities.
• Collaborates with the Regional Care Directors on the Clinical Excellence Committee to identify “best practices” in the community so that those practices can be shared in an efficient and expeditious manner to improve care; these may be practices within panels or community resources available to practices/panels; also works with RCDs to develop and/or improve policies, procedures and guidelines and to lead the Clinical Excellence Committee
• Review randomized selected care plans weekly to assess quality and appropriateness. Deliver feedback to RCD on quality trends.

4. Acts as a project manager for departmental projects as assigned by Manager, PCMH Training & Quality Improvement.  Provides facilities and logistics support for events.

The position has no direct reports, but may provide oversight, feedback and guidance to new and seasoned members of the PCMH teams. Responsible for providing oversight feedback to management on trainees. Must be familiar with operational metrics to ensure graduates are performing within programmatic guardrails.

This position is part of a team responsible for the training and professional development of Healthways LCCs (primary), and CareFirst Regional Care Directors and Program Consultants (secondarily).  The position serves as an internal expert for analysis of training needs and the subsequent instructional design and curricula design and measurements for PCMH training programs and monthly professional development events. 

This position relates to, and must be able to interface with all levels of PCMH team members, including senior management. As a member of the Training & Quality department, he/she bears a special responsibility to model positive behavior for the organization. 

Required Experience/Skills/Abilities:

Bachelor’s degree in Nursing, Human Resources, Healthcare Administration or related field or equivalent experience plus a minimum 5-7 years of increasingly responsible related experience in relevant health care field. 

In addition:
• Position requires 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. 
• Strong interpersonal skills and the ability to work with clinical and non-clinical staff.
• Self-initiative, judgment discretion and decision-making to achieve organizational goals and objectives.
• Ability to work independently and as a highly functioning team member.
• Ability to facilitate meetings in an efficient and effective manner.
• Experience with computer programs such as Microsoft Word, Excel, Access, PowerPoint and Outlook.
• Incumbent should be able to manage multiple priorities, demonstrate flexibility and possess a high degree of tolerance for ambiguity and change is important. 
• 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.

• 1-3 years of experience in instructional design, curriculum development and implementation and program evaluation in a formal training environment. 
• Proven leadership experience
• Experience with alternative forms of training such as e-learning, web-based training or other media.
• Current RN license in DC, MD or VA. 
• Master’s degree in Nursing and/or Instructional Design.
• Knowledge of population health.
• Experience with electronic medical records and disease registries.
• Knowledge and understanding of health care programs, including planning, implementation, and evaluation.
• Knowledge of Process Improvement using Lean Methodology.
• Additional course work in business, healthcare management or instructional design. 
• Working knowledge of and experience in OD theories and practices.  Instructional Systems Design (ISD) experience and certifications. 


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: 1/25/2021

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.


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

Learn more about Medical Management