[Hiring] Quality Management Nurse Consultant @CVS Health

Role Description

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 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.
• 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.

Qualifications

• 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.

Requirements

• Master’s degree in healthcare related field preferred.
• Certified Professional in Healthcare Quality (CPHQ) preferred.
• BSN required.
• Master's degree in healthcare related field preferred.

Benefits

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