[Remote] Quality Management, Nurse Consultant at CVS Health

Illinois, United States

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$60,522 – $129,615Compensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

5 years experience in managed care, clinical, or health care related field
1 year of project management experience
Registered Nurse (RN) license in the state of their residence
Bachelors Degree required

Responsibilities

Ensures the delivery of evidence-based care and services for members according to HFS quality strategy and ABHIL population health model
Directs analysis and reporting of member and provider data to monitor interventions and effectiveness
Plans, conducts and evaluates targeted member/provider initiatives and supports the development of HEDIS interventions and initiatives within the Quality Management Team
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

Skills

Key technologies and capabilities for this role

HEDISQuality ManagementData AnalysisProject ManagementRegistered NurseManaged CarePopulation HealthClinical CriteriaEvidence-Based Care

Questions & Answers

Common questions about this position

What is the pay range for the Quality Management, Nurse Consultant role?

The typical pay range is $60,522.00 - $129,615.00, depending on factors like experience, education, and geography. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program.

What benefits are offered for this position?

Benefits include affordable medical plan options, a 401(k) plan with matching company contributions, an employee stock purchase plan, and no-cost programs like wellness screenings, tobacco cessation, and weight management.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What are the required qualifications for this role?

Candidates need 5 years of experience in managed care, clinical, or health care related field, 1 year of project management experience, an active Registered Nurse (RN) license in the state of residence, and a Bachelor's Degree.

What is the company culture like at CVS Health?

CVS Health fosters a workplace where every colleague feels valued and belongs, with teams reflecting the customers, patients, and communities served, and a commitment to transforming health care with heart.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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