[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.
• 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.
• Manages and coordinates specific workplans for assigned POSC workgroups.
• Facilitates relevant workgroups and committees 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.
• Stays up to date on healthcare innovations, quality studies and evidence-based practices.
• Provides training and education to healthcare professionals, staff, and stakeholders on HEDIS and CAHPS related performance.
• Collaborates with all POSC stakeholders and participants to ensure cross-functional collaboration.

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.
• Strong interpersonal, critical thinking, and analytic skills.
• Working knowledge of quantitative/qualitative data analytics.
• 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.
• Ability to function in clinical setting with diverse cultural dynamics.
• 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 skills.
• Adept at execution and delivery 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

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.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.

Company Description

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.