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

The QM Consultant has a key role in developing and implementing data-driven strategies/interventions that support the delivery of high quality health benefits and services for members. The QM Consultant manages specific vendor relationships that support member engagement and promote increased access to health care and services and to close quality and health equity gaps. The QM Consultant drives value through driving these partnerships and strategic interventions to improve member experience with Aetna and related HEDIS rates. This role has responsibility for the design, content and reporting of member and provider incentive programs, as well as tracking and measuring effectiveness of those incentives. The QM Consultant coordinates, prepares and delivers committee reports, reviews documentation and interprets data in line with HEDIS, regulatory, and accreditation requirements for patterns, population outcomes and to support the achievement of organizational quality goals.

REQUIRED QUALIFICATIONS

• 3+ years experience in clinical, managed care, or health related field.
• RN license in the state of their residence.

PREFERRED QUALIFICATIONS

Certification in project management and / or health care quality

EDUCATION

Bachelor’s degree required, masters degree in related field preferred

Please refer the Job description for details