Quality Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Schedule

Monday-Friday 8a-5p EST/CST

Position Summary
Applies specialized clinical and industry knowledge and performance improvement best practices to quality improvement efforts.Analyzes workflow and organizational performance toevaluate effectiveness of interventions andensure continuous alignment with regulatory and accreditation standards.Supportsanddrives the implementation,measurement, and evaluation ofPOSCCouncilworkplans.Supports POSC Council and executive sponsors to advance initiatives aimedto achieve HEDIS and CAHPS goals.Provides insights and recommendations tooptimize healthcare practices and achieve highest standards of care and service delivery, in alignment with industry and accreditation best practices. 

Primary Job Duties & Responsibilities 

• Develops and implements qualityimprovement programs and initiatives tomonitor and improve healthcare services and processes.Quantitatively and qualitativelyanalyzesorganizational systems and performance in alignment with regulatory and accreditation standards.  

• Drives and implementsevidence-basedperformance improvement interventionsthat address areas for improvement, reduce variations in care, and enhance clinical effectiveness.Establishes, tracks and monitors process and outcome measures.Preparesmaterials andorganizational documents andeffectivenessforPOSC Forum, POSCCouncil and POSC workgroup discussions in alignment with relevant project plans.   

• Manages and coordinatesspecific workplans for assigned POSC workgroups.Facilitates relevant workgroups and committees as required toensure stakeholder awareness and participation.  

• Contributes to enhancing healthcare services, improving patient outcomes, and ensuring adherence to regulatory requirements and industry standards.  

• Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus onsystem performance,network provider and community partner performance, andaddressing barriers including health disparity and health related social needs,toimprove clinical quality, promotebest member and provider experience, and ensurepatient safety. 

• Staysup to date on healthcareinnovations,qualitystudies and evidence-based practices byparticipating in research efforts, contributing to scholarly publications, and/orfacilitating researchutilization to improve clinical care and outcomes. 

• Provides training and education to healthcare professionals, staff, and stakeholders on HEDIS and CAHPS related performance,workflow, and dependencies.  

• Collaborates with all POSC stakeholders and participants to ensure cross-functionalcollaboration,education and participation inestablishing,measuring and evaluatingbest practice interventions aimed to achieveQuality performance goals.   

Required Qualifications

Essential Qualifications and Functions: The minimum knowledge, skills, and abilities (KSAs) which are absolutelyrequired to successfully perform  

• 5-7 yearspriorrelevantworkexperience–in clinical,case management,administrative, quality /compliance orHEDIS performance-based roles 

• In depth knowledge ofmanaged care quality, HEDIS and STARs measures, as wellas  initiatives aimed to driveperformance 

• Stronginterpersonal,critical thinking,andanalytic skills 

• Working knowledge ofquantitative / qualitativedata analytics,andcritical thinking skills. 

• Working knowledge of clinical and practice requirementsessential to meet patient care needs. 

• Ability to deal tactfully with customers andcommunity. 

• Ability tomanage sensitive information ethically and responsibly.  

• Ability to consider the relative costs and benefits of potential actions to choose the mostappropriate option. 

• Ability to function in clinicalsetting with diverse cultural dynamics of clinical staff and patients. 

• Excellentcommunication/presentation andtechnical writingskills 

• Registered Nurse (RN)required.Adept at problem solving anddecision-making skills 

• Adept at collaboration and teamwork  

• Adept at growth mindset (agility and developing yourself and others) skills 

• Adept at execution and delivery (planning, delivering, and supporting) skills

Preferred Qualifications

• Master’s degree in healthcare related field 

• Certified Professional in Healthcare Quality (CPHQ) preferred. 

Education

BSN required

Master's degree in healthcare related field preferred

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and onBenefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.