Quality Management Nurse Consultant

CVS Health; Town of King (WI); Teletrabalho; USD 67 000 - 143 000; Tempo integral

Resumo da oferta

CVS Health is seeking a RN‑led Quality Improvement professional to apply clinical expertise and performance-improvement best practices. You will analyze workflows, measure outcomes, and drive POSC council workplans to achieve HEDIS and CAHPS goals while aligning with regulatory standards.

The role emphasizes collaboration with POSC stakeholders, development of policies, and education for healthcare professionals. Strong communication and data analysis skills are essential.

Qualificações

• Minimum 5–7 years in clinical, case management, administrative, quality or HEDIS roles.
• RN license is required and active.
• In-depth knowledge of managed care quality, HEDIS and STARs.
• Strong interpersonal and analytical skills.
• Ability to analyze data and support decisions.

Responsabilidades

• Develops and implements quality improvement programs to monitor care quality.
• Analyzes organizational performance against regulatory standards.
• Coordinates POSC workplans and facilitates committees.
• Contributes to policies improving provider and patient outcomes.
• Stays current on healthcare innovations and evidence-based practices.
• Provides training on HEDIS and CAHPS performance and workflows.
• Ensures cross-functional collaboration across POSC stakeholders.

Conhecimentos

RN knowledge

HEDIS knowledge

CAHPS familiarity

Data analysis

Quality improvement

Critical thinking

Communication skills

Formação académica

BSN

Master’s degree preferred

RN license

Descrição da oferta de emprego

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 WFH- Monday through Friday 8a-5p in time zone of residence.

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 Masters degree in relevant area preferred

Anticipated Weekly Hours

40

Time Type

Full time

Full time Pay Range

The typical pay range for this role is:
$66,575.00 - $142,576.00 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 .

We anticipate the application window for this opening will close on: 10/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.