QM Nurse Consultant
About The Position
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. Position Summary 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, and 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.
Requirements
- 3-5 years Prior Relevant Work Experience
- Active Registered Nurse (RN) required
Nice To Haves
- 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
Responsibilities
- 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.
- Strengthens WV Medicaid’s ability to improve member outcomes through clinically guided, member‑centric quality interventions.
- Brings licensed nursing expertise to quality management activities, with a primary focus on identifying member needs, supporting care gap closure, and collaborating with interdisciplinary teams to address barriers to care.
- Applies clinical judgement to guide quality initiatives, prioritize member engagement, and support adherence to evidence-based care.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
