QM Nurse Consultant

Position Summary Applies specialized clinical knowledge to participate in quality improvement efforts to assess and enhance patient care. Collaborates with the healthcare quality team to collect and analyze clinical data, participate in quality reviews, and identify opportunities for process improvement. Provides insights and recommendations to optimize healthcare practices and promote patient safety and satisfaction. The QM Nurse Consultant (Nurse Navigator) role strengthens WV Medicaid’s ability to improve member outcomes through clinically guided, member‑centric quality interventions. This role brings licensed nursing expertise to quality management activities, with a primary focus on identifying member needs, supporting care gap closure, and collaborating with interdisciplinary teams to address barriers to care. The QM Nurse Consultant applies clinical judgement to guide quality initiatives, prioritize member engagement, and support adherence to evidence‑based care. Required Qualifications Prior relevant work experience: 3–5 years Active Registered Nurse (RN) required Preferred Qualifications Certified Professional in Healthcare Quality (CPHQ) preferred Experience with clinical or quality improvement and process improvement Manage care experience preferred Experience working with the Medicaid population Education Bachelor’s degree preferred/specialized training/relevant professional qualification Anticipated Weekly Hours 40 Time Type Full time Pay Range $54,095.00 – $142,576.00 The typical pay range for this role is 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. Benefits 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. 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. Equal Opportunity Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr