QM Nurse Consultant

CVS Health • Sacramento, CA • 2h ago

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Requisition Job Description

Primary Job Duties & Responsibilities

Develops and implements quality assurance programs and initiatives to monitor and improve healthcare services and processes.

Communicates with healthcare professionals to develop and implement quality improvement initiatives that enhance the quality and consistency of patient care.

Monitors and ensures compliance with relevant laws, regulations, and accreditation standards by conducting regular reviews, assessments, and audits to identify and address areas of non-compliance.

Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus on improving clinical quality and ensuring patient safety.

Collaborates with cross-functional teams, such as legal, clinical operations, and regulatory affairs, to ensure policies are up-to-date, aligned with industry best practices, and reflect regulatory requirements.

Analyzes data, identifies trends, and implements evidence-based practices that address areas for improvement, reduce variations in care, and enhance clinical effectiveness.

Provides training and education to healthcare professionals, staff, and stakeholders on quality assurance, patient safety, and compliance-related topics.

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

Stays up-to-date on healthcare quality studies and evidence-based practices by participating in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes.

Required Qualifications:

Registered Nurse (RN) required.

Working knowledge of problem solving and decision making skills.

Working knowledge of medical terminology.

Working knowledge of digital literacy skills.

Ability to deal tactfully with customers and community.

Ability to handle sensitive information ethically and responsibly.

Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.

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

3-5 years of direct care clinical experience as an RN required.

Active and unrestricted RN licensure required in candidate's state of residence.

2 years' experience with MS Office suite applications including Excel. Strong computer skills utilizing multiple systems and applications at the same time.

Must have critical thinking skills.

Preferred Qualifications:

Certified Professional Coder (CPC) preferred.

Experience with ICD-10, CPT coding

Experience with QNXT

Experience with QuickBase.

Experience with Cotiviti Editing/CXT

Education:

Bachelor's degree preferred/specialized training/relevant professional qualification.

Prior Relevant Work Experience

3-5 years

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $155,538.00

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 09/23/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Similar Jobs

Staff Nurse II - South Sacramento Emergency (Night/32)

Kaiser Permanente • Sacramento, CA • 1h ago

Hospital & Medical

Job Summary: The Registered Nurse (RN) II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therape...

1h ago

Go to Apply

Staff Nurse II- So Sacramento Hospital North - Emergency -Evening (30 hrs)

Kaiser Permanente • Sacramento, CA • 1h ago

Hospital & Medical

1h ago

Go to Apply

Licensed Vocational Nurse

Dignity Health • Sacramento, CA • 2h ago

Hospital & Medical

Responsibilities Job Summary: The incumbent provides skilled, technical nursing care or service to patients and residents according to a plan of care established by a Registered Nurse and in accordance with current feder...

2h ago

Go to Apply

QM Nurse Consultant

CVS Health • Sacramento, CA • 2h ago

Hospital & Medical

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions compan...

2h ago

Go to Apply

Registered Nurse / RN

BrightSpring Health Services • Sacramento, CA • 2h ago

Hospital & Medical

Our Company ResCare Community Living Overview Join a team of passionate and caring clinicians who make a difference in people's lives. Our nursing group focuses on compassion and meeting the needs of our clients in a var...

2h ago

Go to Apply

Physical Therapist / PT

BrightSpring Health Services • Sacramento, CA • 20h ago

Hospital & Medical

Our Company Rehab Without Walls Neuro Rehabilitation Overview Make an Impact in our Home and Community Program: Who we are looking for: An experienced PT, enthusiastic about providing functional rehabilitation wherever l...

20h ago

Go to Apply

Physical Therapist - Corrections - Part Time Flexible Hours

Amergis • Sacramento, CA • 20h ago

Hospital & Medical

Salary: $528 / Week The Physical Therapist is responsible for performing patientevaluations, as well as providing and documenting therapy services inaccordance with the plan of care developed for each individual patient...

20h ago

Go to Apply

Aetna Pharmacy Performance Analytics - Senior Manager

CVS Health • Sacramento, CA • 21h ago

Hospital & Medical

21h ago

Go to Apply

Aetna Pharmacy Performance Analytics - Manager

CVS Health • Sacramento, CA • 21h ago

Hospital & Medical

21h ago

Go to Apply

Medical Administrative Assistant

TEKsystems • Sacramento, CA • 1d ago

Hospital & Medical

Job Title: Medical Administrative Assistant Overview: We're seeking a self-motivated multitasker to join a fast-paced medical office specializing in injury evaluations for workers' compensation and accident-related cases...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.