[Hiring] QM Nurse Consultant @CVS Health

Role Description

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
• 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.

Qualifications

• Prior Relevant Work Experience: 3-5 years
• Active Registered Nurse (RN) required

Requirements

• 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
• Bachelor's degree preferred/specialized training/relevant professional qualification

Benefits

• Comprehensive benefits package designed to support physical, emotional, and financial well-being
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility