QM Nurse Consultant

CVS Health • Dover, DE • 2d 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.

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.

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