Quality Management Nurse Consultant

CVS Health • Washington, DC

2d • $66,575 - $142,576 • Remote

About The Position

The Quality Management Nurse Consultant applies specialized clinical and industry knowledge and performance-improvement best practices to quality initiatives. The role analyzes workflows and organizational performance to assess intervention effectiveness and maintain alignment with regulatory and accreditation standards. It supports and drives implementation, measurement, and evaluation of POSC Council workplans and helps POSC Council members and executive sponsors advance initiatives to achieve HEDIS and CAHPS goals. The consultant provides insights and recommendations to optimize healthcare practices and promote high standards of care and service delivery.

The position develops quality-improvement programs, implements evidence-based interventions, tracks process and outcome measures, and coordinates assigned POSC workgroup plans. It prepares materials for POSC forums, councils, and workgroups; facilitates committees; contributes to policies and procedures; provides education on HEDIS and CAHPS performance; and collaborates with stakeholders on interventions intended to improve quality and patient outcomes, address health disparities and health-related social needs, and support patient safety and positive member and provider experiences.

Requirements

• Registered Nurse (RN) required.
• Bachelor of Science in Nursing (BSN) required.
• 5–7 years of 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, and initiatives that drive performance.
• Strong interpersonal, critical-thinking, and analytical skills.
• Working knowledge of quantitative and qualitative data analytics.
• Working knowledge of clinical and practice requirements essential to meet patient-care needs.
• Ability to deal tactfully with customers and the community.
• Ability to manage sensitive information ethically and responsibly.
• Ability to weigh the relative costs and benefits of potential actions and choose an appropriate option.
• Ability to function in clinical settings with diverse cultural dynamics among clinical staff and patients.
• Excellent communication, presentation, and technical-writing skills.
• Problem-solving and decision-making skills.
• Collaboration and teamwork skills.
• Growth mindset, including agility and developing oneself and others.
• Execution and delivery skills, including planning, delivering, and supporting.

Nice To Haves

• Master’s degree in a healthcare-related field.
• Certified Professional in Healthcare Quality (CPHQ).

Responsibilities

• Develop and implement quality-improvement programs and initiatives to monitor and improve healthcare services and processes.
• Analyze organizational systems and performance quantitatively and qualitatively in alignment with regulatory and accreditation standards.
• Implement evidence-based performance-improvement interventions to address improvement opportunities, reduce variation in care, and enhance clinical effectiveness.
• Establish, track, and monitor process and outcome measures.
• Prepare materials and organizational documents for POSC Forum, POSC Council, and POSC workgroup discussions in alignment with project plans.
• Manage and coordinate workplans for assigned POSC workgroups.
• Facilitate relevant workgroups and committees to support stakeholder awareness and participation.
• Contribute to improving healthcare services and patient outcomes and to adherence to regulatory requirements and industry standards.
• Contribute to the development, revision, and implementation of policies, procedures, and guidelines addressing system, network-provider, and community-partner performance; health disparities; and health-related social needs.
• Stay current on healthcare innovations, quality studies, and evidence-based practices through research participation, scholarly publications, and/or facilitating research utilization.
• Provide training and education to healthcare professionals, staff, and stakeholders on HEDIS- and CAHPS-related performance, workflows, and dependencies.
• Collaborate with POSC stakeholders and participants to support cross-functional collaboration, education, participation, and evaluation of best-practice interventions aimed at quality performance goals.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• CVS Health bonus, commission, or short-term incentive program, subject to eligibility

What This Job Offers

• Job Type: Full-time
• Career Level: Senior