Quality Management Nurse Consultant

CVS Health•Indianapolis, MA

4d•$60,522 - $129,615

About The Position

The Quality Management Nurse Consultant applies specialized clinical and industry knowledge and performance-improvement best practices to quality-improvement efforts. The role analyzes workflows and organizational performance to evaluate intervention effectiveness and ensure ongoing alignment with regulatory and accreditation standards. It supports and drives implementation, measurement, and evaluation of POSC Council workplans, and works with POSC Council members and executive sponsors to advance initiatives targeting HEDIS and CAHPS goals. The consultant provides insights and recommendations to optimize healthcare practices and support high standards of care and service delivery. The position develops and implements quality-improvement programs and initiatives, analyzes organizational systems and performance, and drives evidence-based interventions. It coordinates and facilitates assigned POSC workgroups and committees, monitors process and outcome measures, and prepares materials and documents for POSC forums, councils, and workgroups. It also contributes to policies and practices addressing system, provider, and community-partner performance, health disparities, health-related social needs, clinical quality, member and provider experience, and patient safety. The role provides education on HEDIS and CAHPS performance and collaborates with stakeholders to establish, measure, and evaluate interventions. The schedule is Monday through Friday, 8 a.m. to 5 p.m. EST/CST. This is a full-time position with 40 anticipated weekly hours. The stated typical pay range is $60,522 to $129,615, with eligibility for a CVS Health bonus, commission, or short-term incentive program. The role is eligible for a benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Requirements

Registered Nurse (RN) required.
Bachelor of Science in Nursing (BSN) required.
5–7 years of 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 aimed at driving 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 meeting patient-care needs.
Ability to deal tactfully with customers and the community.
Ability to manage sensitive information ethically and responsibly.
Ability to weigh relative costs and benefits to select appropriate actions.
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 areas, 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 enhancing healthcare services, improving patient outcomes, and ensuring adherence to regulatory requirements and industry standards.
Contribute to developing, revising, and implementing policies, procedures, and guidelines addressing system, provider, and community-partner performance, barriers, health disparities, and health-related social needs.
Keep up to date on healthcare innovations, quality studies, and evidence-based practices through research participation, scholarly publications, 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, and participation in establishing, measuring, and evaluating interventions toward quality performance goals.