RN Clinical Quality & Education Specialist

Job Description

Job Description

About Shearwater Health:

At Shearwater Health, we know that better patient outcomes are never achieved alone – especially when there aren’t enough hands to deliver care. That’s why we’ve built something different: a global team of clinicians helping solve one of healthcare’s most urgent challenges – the nursing shortage. By expanding the reach of care teams and reinforcing critical support systems, we bring clarity, compassion, and clinical expertise to the front lines of care.

As the founder of the nation’s first Clinical Process Outsourcing (CPO®) model and a  Great Place to Work®-certified company, we help the world’s top healthcare organizations work smarter – scaling their teams, strengthening care, and solving real problems every day. From clinical decision support to administrative tasks, our team of nearly 6,000 clinicians and process experts work across borders and time zones to help our partners focus on what matters most: delivering exceptional patient care.

If you’re ready for your work to not just support care – but strengthen the system – join us. This is where clinicians become changemakers, and where nurses go further than they ever thought possible.

As the face of the Shearwater Domestic Clinical Education and Quality program, you will be responsible for designing, delivering, evaluating, and continuously improving training programs while also evaluating the quality, accuracy, compliance, and effectiveness of care management activities. This dual-function role connects training and quality by using audit findings, learner outcomes, and performance trends to identify gaps, deliver targeted education and coaching, and monitor improvement. The role ensures employees are clinically competent, operationally proficient, and prepared to meet health plan, client, quality, regulatory, and accreditation requirements. Other duties may be assigned to support the business. 

Training Program Development 

• Develop and maintain onboarding, upskilling, refresher, and continuing education programs. 
• Create training curricula, lesson plans, facilitator guides, job aids, reference materials, case studies, simulations, and competency assessments. 

• Align training content with health plan policies, clinical workflows, client expectations, quality standards, and regulatory and accreditation requirements. 

• Update training materials based on policy, process, regulatory, client, or system changes. 

• Apply adult learning principles and instructional design methodologies to support learner engagement, knowledge retention, and transfer to job performance. 

New Hire Onboarding 

• Facilitate clinical and operational onboarding for new care management staff.
• Provide orientation to health plan operations, care management programs, member populations, systems, workflows, documentation standards, and performance expectations. 

• Assess learner readiness after transition to production responsibilities. 

• Maintain accurate training, attendance, assessment, remediation, and competency documentation. 

Clinical & Operational Education 

• Deliver virtual, classroom, and hybrid training on utilization management
• Reinforce evidence-based practices, clinical requirements, documentation standards, and workflow expectations. 
• Deliver targeted refresher training and corrective education based on audit findings, operational changes, and identified performance gaps. 

Clinical Quality Auditing 

• Conduct audits of utilization management activities, documentation, Evaluate compliance with health plan policies, clinical guidelines, evidence-based practices, client requirements, and established quality standards. 
• Review records for completeness, accuracy, timeliness, clinical appropriateness, and documentation quality. 
• Identify documentation deficiencies, compliance risks, clinical or operational errors, and performance gaps. 
• Complete assigned audit volumes and reporting within established service level agreements, key performance indicators, and turnaround expectations. 
• Maintain appropriate separation between coaching and final audit scoring to support objectivity and audit integrity. 

Regulatory & Accreditation Compliance 

• Train staff and monitor performance related to NCQA, URAC, CMS, HIPAA, state and federal regulations, and client-specific requirements. 
• Interpret applicable requirements and translate them into training content, competency expectations, audit criteria, and quality controls. 
• Ensure training and audit processes support accreditation readiness and regulatory compliance. 
• Identify and escalate trends or risks that may affect quality, compliance, accreditation, or client outcomes. 

Competency Assessment, Coaching & Performance Improvement 

• Conduct knowledge checks, simulations, case studies, audits, and competency evaluations. 
• Provide objective, constructive, and actionable feedback through one-on-one and group coaching.
• Develop and support remediation, corrective education, and performance improvement plans when gaps are identified. 
• Perform root cause analysis on recurring quality issues and recommend training, workflow, policy, or process changes. 
• Monitor post-training and post-coaching performance to evaluate intervention effectiveness and sustained improvement. 

Calibration & Audit Reliability 

• Participate in and support auditor calibration activities to promote consistent scoring and interpretation. 
• Support inter-rater reliability initiatives and quality standardization efforts.
• Apply audit tools, scorecards, sampling requirements, and scoring methodologies consistently. 
• Assist with the development, testing, maintenance, and revision of audit tools, scorecards, evaluation criteria, and quality-related competency assessments. 

Learning Technology, Reporting & Data Analysis 

• Use Learning Management Systems to assign, track, and report training completion and competency results. 
• Prepare and distribute training reports, audit reports, scorecards, and trend analyses. 
• Monitor training effectiveness, audit scores, error rates, quality metrics, learner outcomes, and compliance trends. 
• Present findings, risks, and recommendations to Operations, Compliance, Client Success, and Leadership teams. 
• Use audit and training data to support operational decision-making and continuous improvement. 

Stakeholder Collaboration 

• Partner with Clinical Operations, Compliance, Accreditation, Client Success, client stakeholders, and Leadership teams. 
• Support implementation of new programs, workflows, technologies, audit requirements, and client changes. 
• Participate in case reviews, quality committees, project teams, and operational improvement initiatives. 
• Serve as a subject matter expert for utilization management education, documentation quality, compliance, competency, and audit expectations. 

• New hire training success, learner readiness, and speed to proficiency 
• Training completion, competency assessment, and compliance rates 
• Audit accuracy, reliability, timeliness, and required throughput 
• Inter-rater reliability and consistent application of audit standards 
• Documentation quality improvement and reduction in recurring defects 
• Measurable improvement following coaching, remediation, and training interventions 
• Identification and appropriate escalation of compliance risks 
• Quality and timeliness of training materials, audit tools, reports, scorecards, and trend analyses 
• Collaboration with the client on updates and modifications needed to improve program quality and content 
• Ability to pivot training, quality tools, and content to meet changing or ad hoc business needs 
• Support of accreditation, regulatory, client quality, SLA, and KPI goals 

• Minimum requirement Associate Degree in Nursing, Bachelor of Science in Nursing preferred
• Current, active, unrestricted RN license in any state with the ability to obtain the State of Michigan Nursing License (exclusions: Northern Mariana Island, Guam, Puerto Rico)
• Must be able to obtain additional licenses as required
• Minimum of 2 years of clinical bedside experience.
• Minimum of 1 year of utilization management and/or case management experience (can be a combination)
• Experience in managed care, utilization  management,required  
• Experience applying MCG and/or InterQual® clinical guidelines in utilization management, case management, care coordination, or quality review activities preferred.
• Experience developing, delivering, or auditing training and clinical decision-making processes utilizing MCG and InterQual® criteria preferred. MCG and/or InterQual® trainer certification a plus.
• Previous clinical education experience, including designing, delivering, and evaluating training for adult learners, required. 
• Experience facilitating virtual, classroom, or hybrid training for clinical and non-clinical audiences required. 
• Experience conducting clinical audits, quality reviews, or regulatory compliance assessments required. 
• Experience evaluating clinical documentation, case files, and operational processes for quality and compliance required. 
• Strong understanding of payer, provider, and/or workers' compensation workflows, clinical documentation standards, care management processes, and member-centered care required. 
• Proficiency in adult learning principles, instructional design, competency assessment, coaching, and remediation required. 
• Understanding of audit methodologies, calibration, inter-rater reliability, quality monitoring, root cause analysis, corrective action planning, and performance improvement required. 
• Ability to interpret regulatory, accreditation, and client requirements and translate them into training content, audit criteria, job aids, and practical workflow expectations preferred. 
• Knowledge of CMS, NCQA, URAC, HIPAA, and state-specific regulatory requirements preferred. 
• Experience using quality metrics, scorecards, dashboards, and audit results to identify trends, risks, and performance gaps required. 
• Proficiency with Microsoft Office Suite, including Excel, Learning Management Systems, reporting tools, and quality management systems required. 
• Strong presentation, facilitation, public-speaking, written communication, coaching, and feedback skills required. 
• Strong critical thinking, clinical judgment, decision-making, organization, and attention to detail required. 
• Ability to work independently, manage competing priorities and tight deadlines, maintain objectivity, and escalate concerns appropriately. 
• Comfort working and delivering training in a remote, technology-enabled environment from a private, distraction-free office space. 
• Previous experience in a global, matrixed healthcare organization preferred. 
• Ability to travel at least 10% as needed for client or corporate meetings and events. 

• A competitive compensation structure
• Comprehensive health insurance
• 401(k)
• Paid vacation time
• The opportunity to build your career in a rewarding and unforgettable way