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 to evaluate effectiveness of interventions and ensure continuous alignment with regulatory and accreditation standards. Supports and drives the implementation, measurement, and evaluation of POSC Council workplans. Supports POSC Council and executive sponsors to advance initiatives aimed to achieve HEDIS and CAHPS goals. Provides insights and recommendations to optimize 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 quality improvement programs and initiatives to monitor and improve healthcare services and processes. Quantitatively and qualitatively analyzes organizational systems and performance in alignment with regulatory and accreditation standards. Drives and implements evidence-based performance improvement interventions that address areas for improvement, reduce variations in care, and enhance clinical effectiveness. Establishes, tracks and monitors process and outcome measures. Prepares materials and organizational documents and effectiveness for POSC Forum, POSC Council and POSC workgroup discussions in alignment with relevant project plans. Manages and coordinates specific workplans for assigned POSC workgroups. Facilitates relevant workgroups and committees as required to ensure 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 on system performance, network provider and community partner performance, and addressing barriers including health disparity and health related social needs, to improve clinical quality, promote best member and provider experience, and ensure patient safety. Stays up to date on healthcare innovations, 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. 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-functional collaboration, education and participation in establishing, measuring and evaluating best practice interventions aimed to achieve Quality performance goals. Required Qualifications Essential Qualifications and Functions The minimum knowledge, skills, and abilities (KSAs) which are absolutely required to successfully perform 5-7 years prior relevant work experience - in clinical, case management, administrative, quality / compliance or HEDIS performance-based roles In depth knowledge of managed care quality, HEDIS and STARs measures, as well as initiatives aimed to drive performance Strong interpersonal, critical thinking, and analytic skills Working knowledge of quantitative / qualitative data analytics, and critical thinking skills. Working knowledge of clinical and practice requirements essential to meet patient care needs. Ability to deal tactfully with customers and community. Ability to manage 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. Excellent communication/presentation and technical writing skills Registered Nurse (RN) required. Adept at problem solving and decision-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 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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. 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. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. Application Close We anticipate the application window for this opening will close on: 10/17/2026 Our Work Experience Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators