QM Nurse Consultant

at  CVS Health

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary: Ensures the delivery of evidence-based care and services for members according to HFS quality strategy and ABHIL population health model. The QM Consultant directs analysis and reporting of member and provider data to monitor interventions and effectiveness. The QM Consultant plans, conducts and evaluates targeted member/provider initiatives and supports the development of HEDIS interventions and initiatives within the Quality Management Team. The QM Consultant reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with HEDIS, regulatory, and accreditation requirements for member and/or provider issues. Works closely with the Quality team, leadership and POSC to drive population-based improvements in care and outcomes.

REQUIRED QUALIFICATIONS

5 years experience in managed care, clinical or health-related field.
1+ years of project management experience.
RN license in the state of their residence.

EDUCATION

Bachelors degree with health related concentration

Please refer the Job description for details